School Year 21-22 COM-F004 Digital Media/Photograph/Video/Internet Authorization Form

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Sacramento City Unified School District School Year 2020-2021

Email *

Student First Name *

Student Last Name *

I give permission for photos/video, as well as relevant class work, of my child, to be used by the media or Sacramento City Unified School District for publication on the district website, www.scusd.edu, and all related SCUSD publications and Internet sites, including, but not limited to, school and/or club sponsored webpages.

Yes

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I, the undersigned, am parent and/or legal guardian of the student noted on this document, and hereby fully release and discharge the Sacramento City Unified School District, its officers, employees, agents, servants, and volunteers for any and all liability arising out of in connection with the above described independent activity and all liabilities associated with any and all claims related to such activity that may be filed on behalf of or for the above-named minor. For the purposes of this release, "liability" means all claims, demands, losses, causes of action, suits or judgments of any and every kind that arise as a result of the above described activity and resulting from any cause other than the District's gross negligence. - By typing my name below I agree the these terms. *

Date Signed *

YYYY

Parent/Guardian Address *

Parent/Guardian Telephone Number *

Send me a copy of my responses.

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