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Get Chicago Public Schools Media Consent Form and Release 2011

CHICAGO PUBLIC SCHOOLS MEDIA CONSENT FORM AND RELEASE School Date I hereby consent to have relation full name date of birth photographed video taped audio taped or interviewed by the Board of Education of the City of Chicago the Board or the news media when school is in session or when my child is under the supervision of the Board. I understand in the course of the above described activities that the Board might like to celebrate my child s accomplishments and work. Therefore I further consent for the Board s release of information on my child s name academic/non-academic awards and information concerning my child s participation in school-sponsored activities organizations and athletics. CHICAGO PUBLIC SCHOOLS MEDIA CONSENT FORM AND RELEASE School Date I hereby consent to have relation full name date of birth photographed video taped audio taped or interviewed by the Board of Education of the City of Chicago the Board or the news media when school is in session or when my child is under the supervision of the Board. I understand in the course of the above described activities that the Board might like to celebrate my child s accomplishments and work. Therefore I further consent for the Board s release of information on my child s name academic/non-academic awards and information concerning my child s participation in school-sponsored activities organizations and athletics. I also consent to the Board s use of my child s name photograph or likeness voice or creative work s on the Internet or on a CD or any other electronic/digital media or print media* As the child s parent or legal guardian I agree to release and hold harmless the Board its members trustees agents officers contractors volunteers and employees from and against any and all claims demands actions complaints suits or other forms of liability that shall arise out of or by reason of or be caused by the use of my child s name photograph or likeness voice or creative work s on television radio or motion pictures or in the print medium or on the Internet or any other electronic/digital medium* It is further understood and I do agree that no monies or other consideration in any form including reimbursement for any expenses incurred by me or my child will become due to me my child our heirs agents or assigns at any time because of my child s participation in any of the above activities or the above-described use of my child s name photograph or likeness voice or creative work s. I understand that I may cancel my consent by providing written notice to the principal* Signature of Parent or Guardian or Student if age 18 or over I do not consent to my child being photographed video taped audio taped and/or interviewed by the Board or the news media when school is in session or when my child is under the supervision of the Board. I do not consent for the Board to use creative work s generated and/or authored by my child on television radio or motion pictures or in the print medium or on the Internet or any other electronic/digital medium* 773 553. .

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