RELEASE AND CONSENT TO PHOTOGRAPH AND OR VIDEOTAPE English

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RELEASE AND CONSENT TO PHOTOGRAPH AND OR VIDEOTAPE English Powered By Docstoc
					                         Parkside Middle School
                         8602 Mathis Avenue • Manassas, VA 20110
           703.361.3106 • FAX 703.361.8993 • http://parksidems.schools.pwcs.edu/
                               Mary Jane Boynton, Principal



           RELEASE AND CONSENT TO PHOTOGRAPH AND /OR VIDEOTAPE


I, _______________________________________ (print name of parent or
guardian), hereby authorize and give full consent to Parkside Middle School to
copyright and /or publish any photographs or videotapes in which my child,
___________________________________ (print child’s name), a student at
Parkside Middle School may appear.

I also agree that Prince William County Public Schools and Parkside Middle School
may use these photographs or videotapes for any exhibits, public displays,
publications, commercial art, and advertising purposes without limitation or
compensation.


____________________________________________
Signature of parent or guardian



____________________________________________
Witness


____________________________________________
Date

				
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