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Media Consent for NYC Department of Education Use

LIFE Academy High School for Film and Music

Please complete the form below. Required fields marked with an asterisk *

Student's First Name*

Answer Required

Student's Last Name*

Answer Required

I consent to the use and disclosure of the image, quotes, name, the participation in interviews, and the taking of photographs, recordings, and videos of the Student named above by the New York City Department of Education (NYC DOE) and NYC DOE-invited members of the press for NYC DOE-sponsored events. I grant the NYC DOE and invited members of the press the right to disclose, edit, use, and reuse the Student’s image, quotes, name, and interviews, and photographs, recordings, and videos of the Student for the NYC DOE’s nonprofit and public press purposes. This includes use in print, on broadcasts, in online spaces (such as the NYC DOE website and social media accounts and those of the press), and all other forms of media. I understand that when the school hosts a public event, individuals at the event may take their own photographs, videos and audio of the event, that such recordings may capture me or my child, and that they may also be made public.

I also release the NYC DOE, its agents, and employees from all claims, demands, and liabilities in connection with the rights granted above.**

Answer Required

I agree

I do not agree

Parent / Guardian's Name*

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Signature of Parent or Guardian*

Signature Required

Date*

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For students age 18 and over, the form must be signed by the student, and not the parent or guardian. Please see the webpage to print and sign the release form.

Confirmation Email

Confirmation Email *

Email Required