Los Angeles Unified School District Parent/Guardian Publicity Authorization and Release (Virtual Graduation/Culmination)
Dear Parent/Guardian:
The Los Angeles Unified School District requests your permission to reproduce through printed, audio, visual, or electronic means activities in which your pupil has participated in his/her education program. Your authorization will enable us to publish the printed, audio, visual or electronic recordings of your pupil at the virtual graduation/culmination, and to reproduce, distribute and publish said materials for purposes related to the safe celebration of the culminating/graduating experience and to increase public awareness through the use of mass media, displays, brochures, websites, etc.
* Indicates required field
Sign in to Google to save your progress. Learn more
Name of Parent/Guardian (Last, First) *
Address of Parent/Guardian *
Phone of Parent/Guardian *
Name of Student (Last, First) *
Birthday of Student (MM/DD/YYYY) *
Name of your School *
Please read carefully: A. I, as a parent or guardian, of the above named pupil fully authorize and grant the Los Angeles Unified School District and its authorizedrepresentatives, the right to print, photograph, record, and edit as desired, the biographical information, name, image, likeness, and/orvoice of the above named pupil and photographs submitted with relatives and other family members on audio, video, film, slide, or anyother electronic and printed formats, currently developed, (known as “Recordings”), for the purposes stated or related to the above.    B. I and agree that use of such Recordings will be without any compensation to the pupil or the pupil’s parent or guardian.  C. I understand and agree that the Los Angeles Unified School District and/or its authorized representatives shall have the exclusive right,title, and interest, including copyright, in the Recordings.  D. I understand and agree that the Los Angeles Unified School District and/or its authorized representatives shall have the unlimited rightto use the Recordings for any purposes stated or related to the above.   E. I understand and agree that the Los Angeles Unified School District and/or its authorized representatives shall have the unlimited rightto use the Recordings for any purposes stated or related to the above.  F. I hereby release and hold harmless the Los Angeles Unified School District and its authorized representatives from any and all actions,claims, damages, costs, or expenses, including attorney’s fees, brought by the pupil and/or parent or guardian which relate to or arise outof any use of these Recordings as specified above. *
Your name: If I put down my name here, it shows that I have read and understand the release and I agree to accept its provisions. *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of LAUSD. Report Abuse
Google Forms