MEDIA RELEASE FORM

Dear Parent or Guardian:

Through out the school year, the media may visit the school to cover special events. The Escola Portuguesa do Clube Juventude Lusitana may also wish to use your child’s photograph, likeness, voice or student work for promotional and educational reasons, such as in publications, posters, brochures, newsletters, website, radio, TV or at community fair and special events.

Please fill out the below form to either give/ do not give permission to your child.

*Please submit a from per child

Student Name

First Name

Last Name

Permission Selection

Parent/Guardian Signature

Parent/Guardian Email

Parent/Guardian Phone

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