Lake Michigan Academy Photography and Filming Release

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As part of Lake Michigan Academy, your child may be photographed, video-recorded, or interviewed as part of school-related events.

Your signature allows Lake Michigan Academy to be photographed, video-recorded, audio-recorded, or interviewed for instructional purposes and/or public information with the full knowledge that the end product may appear in print publications, on television, in a video, or on the Internet.

With this agreement, you release Lake Michigan Academy, the photographer, their offices, employees, agents, and designees from liability for any violation of any personal or proprietary right you may have in connection with such use.

Email *

Student's Last Name

Student's First Name

I DO give my permission for my child (still, video, audio, or interview) to be included in media promoting Lake Michigan Academy.

I DO NOT give my permission for my child (still, video, audio, or interview) to be included in media promoting Lake Michigan Academy.

Required

Parent / Guardian Name *

This will serve as your signature on this form.

A copy of your responses will be emailed to the address you provided.

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