CESA 11 Student Work/Photo Release Form

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This is to be completed by a parent/guardian (if the student is under 18) or by the student if they are 18 or older.

Email *

Date *

YYYY

Student's Name (First and Last) *

Parent/Guardian Name (First and Last) *

Parent/Guardian's Phone Number (Enter phone number using this format ###-###-####) *

School District

By giving my authorization below, I hereby authorize CESA #11 to publish student work and/or photographs of my child for use in CESA #11 printed publications, online publications, presentations, social media and/or website. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use. *

I give my authorization

Thank you!

Send me a copy of my responses.

Submit

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