2023-2024 Media Release Permission Form

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This form must be filled out separately for each individual child in each family.

Date: *

YYYY

Name of Parent(s)/Guardian(s) completing this form. (By completing this form, I am giving full consent in lieu of a signature.) *

Name of child (one child per form) **Yes, we do need you to fill out one form for each individual child in your family. *

Grade Level: *

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8

I/We hereby give permission to St. Patrick School to use sound, video and photographic images of my son/daughter for news releases, brochures, social media, including but not limited to St. Patrick School sponsored Facebook, Instagram, and Youtube accounts, and/or any other school related productions. Additionally, I give permission for my son's/daughter's image, work, and first name to be used on the school web page. No last names will be used on any school related website or social media platform. I understand, that in not giving permission as stated above, my child will not be able to be a part of any filmed school production or special events videos (such as Jog-a-thon). As all of our final productions are taped, this means that your child can practice with the group, but will not be able to have any special parts or be a part of the final performance. *

I give permission.

I do not give permission and understand the performance restrictions as stated above.

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