Media Release Form
I hereby consent to the taking of photographs, movies, videos, and images capable of reproduction in any medium of me or my children or children of whom I am the designated guardian by the Academy, Roman Catholic Diocese of Brooklyn, and/or Department of Education and their parents, affiliates, trustees, directors, members, officers, employees, volunteers, agents and contractors (the “Parties”).

I hereby grant the Parties the right to edit, reproduce, use and reuse images for any and all purposes including, but not limited to, advertising, promotion and display, and I hereby consent to the editing, reproduction, use and re-use of said images in any and all media in existence and all media yet in existence including, but not limited to, video, print, television, internet, and podcasts.  

I forever grant, assign, and transfer to the Parties any right, title and interest that I and/or my child/children may have in any images, including negatives, taken of me and/or my children by the Parties.  I hereby agree to release, indemnify and hold harmless the Parties from any and all claims, demands, actions or causes of actions, loss, liability, damage, or cost arising from this authorization.




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Email *
Name of Student(s) *
Parent or Guardian Name *
Contact Phone: *
Contact Email: *
I authorize the academy/parish school to use photographs or video of the student(s) listed above for: Academy Website and Social Media Page, Academy Marketing Materials e.g. Brochures, Flyers, Billboards as well as television, digital and print advertisements, Futures in Education Promotion (Diocesan Scholarship Organization) and Promotion of Catholic Education within the Diocese of Brooklyn. I understand that by giving this authorization,  St. Francis de Sales Catholic Academy along with the Diocese of Brooklyn and DeSales Media Group can use the student’s photographs or video for the purposes listed above. *
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