Media Consent Form Consent Form Consent to Photograph, Film, or Videotape a Student for Non-Profit Use(eg. education, public service, or health awareness purposes)Student NameSchoolI hereby consent to the participation in interviews, the use of quotes, and the taking of photographs, movies, or videotapes of the Student named above byI also grant tothe 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 MM slash DD slash YYYY Address of Parent/GuardianORSignature of Student (if 18 or over)Date MM slash DD slash YYYY Address of Parent/Guardian
