Editing previous response:

Please fix the highlighted areas below before submitting.

Photo Consent Form

CONSENT TO PHOTOGRAPH, FILM, OR VIDEOTAPE A STUDENT FOR NON-PROFIT USE

(e.g. educational, public service, or health awareness purposes)

Student Name

Answer required for "Student Name"

Class

Answer required for "Class"

I hereby consent to the participation in interviews, the use of quotes, and the taking of photographs, movies or video tapes of the student named above by MS 319 and the NYC Department of Education.

I also grant MS 319 and the NYC Department of Education the right to edit, use, and reuse said products for non- profit purposes including use in print, on the internet, and all other forms of media. I also hereby release the New York City Department of Education and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above.

Signature of Parent/Guardian*

Signature Required

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"