Media Consent and Release Form
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Student Name *
Student Grade *
I am the parent/guardian of my child.  I hereby grant  Synergy Magnet K12, Inc. and their agents the absolute right and permission to use photographic portraits, pictures, digital images or videotapes and YouTube livestream and videos of my child, or in which my child may be included in whole or part of reproductions thereof in color or otherwise for any lawful purpose whatsoever, including but limited to use in any school publication or on the school website without payment or any other consideration. *
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I hereby waive any right that I may have to inspect and/or approve the finished product or the copy that may be used in connection therewith, wherein my child's likeness appears, or the use to which it may be applied. *
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I hereby release, discharge, and agree to indemnify and hold harmless  Synergy Magnet K12, Inc. and it's agents from all claims and demands and causes of action that I or my child have or may have by reason of this authorization or use of my child's photographic portraits, pictures, digital images, or videotapes, including any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of said images or videotapes, or in the processing tending toward the completion of the finished product, including publication on the internet, in brochures, or any other advertisement or promotional materials. *
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I represent that I'm the legal parent/guardian (18 YEARS OR OLDER) and am fully competent to sign this form. *
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PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY
CONSENT: I hereby certify that we/I are/am the parent/guardian of the above named child and do so hereby give my consent without reservation to the forgoing on behalf of my child.

NON-CONSENT: I hereby certify that we/I are/am the parent/guardian of the above named child and do NOT hereby give my consent without reservation to the forgoing on behalf of my child.
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