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Get NY Consent To Photograph Film Or Videotape A Student For A Non-Profit Use

374. 5584 CONSENT TO PHOTOGRAPH FILM OR VIDEOTAPE A STUDENT FOR NON-PROFIT USE e.g. educational public service or health awareness purposes Student Name School 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 I also grant to. Office of Communications and Media Relations 52 Chambers Street New York NY 10007 Tel 212. 374. 5141 Fax 212. 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 if Student is under 18 Date Address of Parent/Guardian OR Signature of Student if 18 or over Date Address of Student. 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 if Student is under 18 Date Address of Parent/Guardian OR Signature of Student if 18 or over Date Address of Student.

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