Media Release Form

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Student Name*
First Middle Last
Greg Mathis Charter High School - Media Release Form
We need student and parent permission to use a person's photograph, voice, and/or name in various media projects. Please read the following, then date and sign where indicated. Thank You
Consent*
- Yes- I consent. I grant permission for my child to participate and appear in video or audio recordings, instant messaging, photographs, written articles, podcasts or on websites and social media sites. This consent includes the use and editing of my child's image, voice, and name in media projects by Greg Mathis Charter High School, including its employees and contractors, from all claims resulting from the use and editing of my child's image, voice or name, and the use, editing and release to media outlets for school promotion and non-profit fund raising purposes.
- No- I do not consent to non-ASD use of my child's photograph, voice, and/or name in various media projects.
Your selection remains valid for all media projects occurring during the school year in which this form is signed. You may change your selection at any time by completing a new form at your school
Date*
DD slash MM slash YYYY
Student's Name*
First Last
Student Signature*
Parent or Legal Guardian Name*
First Last
Parent or Legal Guardian Signature*
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