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Student Media Release Form

Community School Health Center PS 23Text

Student Media Release Form

DEPARTMENT OF COMMUNICATIONS

Permission to permit the Mahatma K. Gandhi School, PS 23, Community Schools Health Center and their clinicians to use student photo/video/audio on their website and social media and for other district events, promotions and related activities.

I, the undersigned parent/guardian of

do hereby grant permission to the Mahatma K. Gandhi School, PS 23, Community Schools Health Center and/or its designated representative to permit my child’s picture to be taken, or likeness used on the Health N Wellness Services, LLC (Full Service Community School Health Center) website and or social media and or to be otherwise utilized by the district in regard to the district’s approved events and activities including use of name, voice, and /or writings and reproductions of the same in any form.  I hereby release the above party from liabilities arising out of what I might deem misrepresentations by virtue of distortion, optical illusions, or faulty mechanical reproductions.

The publicity my minor child(ren) shall receive by virtue of the first such use that may be made thereof shall be full and adequate compensation for this consent.

I agree all such uses of his/her name, voice, likeness, portrait, pictures, photographs, films, videotapes, audiotapes, or writings and reproductions thereof, including but not limited to tapes, plates, and negatives connected therewith are and shall remain the property of the Mahatma K. Gandhi School, PS 23 and the Community Schools Health Center and their designees.