Student Photograph/Video/Sound Release Form

Student Photo/Video/Sound Release Form

Release for use

I hereby give St. John School permission to use the photograph/video/sound of the minor(s) or myself listed below for their publicity, promotion, news releases, videos, and web use. This may also apply to the written composition or visual art of the minor, or myself if it is published.
St. John School agrees that the students’ name, picture, art, written work, voice, photograph, video or verbal statements shall only be used for public relations, public information, publicity and/or instruction. The school further agrees that students will not be identified by personal details other than first name. These details include email or postal addresses, telephone or fax numbers.
Pictures of one to three students are permitted as long as an appropriate release form has been signed by the parent/guardian of each individual shown in the picture. Pictures of four or more students are permitted without a release form and will be printed without first and last names. No monetary consideration shall be paid.
Consent and release have been given without coercion or duress. The photo, video or student statements may be used in subsequent years. If the Student and/or Parent/Guardian wish to rescind this agreement they may do so at any time with written notice.
St. John School has no control of media use of pictures/statements which are taken without our permission.
Student Name
First Last
Student Name
First Last
Student Name
First Last
Student Name
First Last
Parent/Guardian Name
First Last
Parent/GuardianSignature
Date
MM slash DD slash YYYY
I do not give permission to publish the image or work of my child(ren) or myself.
Signature
Date
MM slash DD slash YYYY