Media Consent Form
 Media Consent for NYC Department of Education Use  
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Email *
Student Name *
Class number *
Name of Parent/Guardian *
Address of Parent/Guardian *
I consent to the use and disclosure of the image, quotes,
name, the participation in interviews, and the taking of
photographs, recordings, and videos of the Student named
above by the New York City Department of Education
(NYC DOE) and NYC DOE-invited members of the press for
NYC DOE-sponsored events. I grant the NYC DOE and
invited members of the press the right to disclose, edit,
use, and reuse the Student’s image, quotes, name, and
interviews, and photographs, recordings, and videos of the
Student for the NYC DOE’s nonprofit and public press
purposes. This includes use in print, on broadcasts, in
online spaces (such as the NYC DOE website and social
media accounts and those of the press), and all other
forms of media. I understand that when the school hosts a
public event, individuals at the event may take their own
photographs, videos and audio of the event, that such
recordings may capture me or my child, and that they may
also be made public. I also release the NYC DOE, its
agents, and employees from all claims, demands, and
liabilities in connection with the rights granted above.
*Below is an image of the actual form. There is no action required for the photo. To provide your consent, please refer to the content below the photo.
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