The New Village - Permission to Publish/Display Form

Permission to Publish/Display Form

Permission Form to Publish and/or Display Student Photographs, Videos and Work/Images
'One form per student please'
As part of the educational program at the New Village School we may have the opportunity to publish and/or display the writing, artwork and projects of the New Village School students in newspapers, magazines or other various venues (such as the public library, local restaurants, theaters, etc.) and on the New Village School website. The New Village School may use photographs and videos of students and/or reproductions of their work to promote the school through the Internet, event flyers, newspapers and/or magazine articles, outreach programs and/or other display opportunities. Promotion materials may include individual and group student photographs, reproductions of class projects, handwork, stories, poems, main lesson books, artwork and/or research projects. We think this is an exciting and enriching opportunity for students and our school. It is ultimately the responsibility of the Management Team to post work that is representative of the New Village School.

Please indicate your permission to publish and/or display photographs and/or videos of your child(ren), as well as reproductions of your child(ren)’s work, by signing below and returning this form to the New Village School.
Student Last Name*
Student First Name*
Date of Birth*

MonthDayYear
Date
Grade Level*
Parent1 Last Name*
Parent1 First Name*
Parent2 Last Name
Parent2 First Name
I, the undersigned parent/guardian of and hereby approve the foregoing and consent to the use of my child(ren)’s photograph and/or work to be published and/or displayed in venues chosen by the New Village School pursuant to the above.
By clicking here, I, the undersigned parent/guardian of the students listed above, hereby approve the foregoing and consent to the use of my child(ren)'s photograph and/or work to be published and/or displayed in venues chosen by the New Village School pursuant to the above.

I do consentI do not consent
Email*
example@example.com
Parent1 /Guardian1 Signature: *

Clear
Date

MonthDayYear
Date
Parent2 /Guardian2 Signature:

Clear
Date

MonthDayYear
Date
www.thenewvillageschool.org

100 Ebbtide Ave • Suite 144 • Sausalito, CA 94965 • Ph: 415.289.0889 • Fax: 415.789.5504
Should be Empty: