Orange High School
400 Lincoln Avenue, Orange NJ 07050
- Orange High School
- Media Consent Form
Shaw, Daneisha - History
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Orange High School
Ms. Shaw Class
Student name________________________________
CONSENT TO PHOTOGRAPH, FILM, OR VIDEOTAPE A STUDENT FOR NON-PROFIT USE (e.g. educational, public service, or health awareness purposes)
I hereby consent to the participation in interviews, the use of quotes, and the taking of photographs, movies or video tapes of the Student named above by_______________________________ . I also grant to______________________________ the right to edit, use, and reuse said products for nonprofit purposes including use in print, on the internet, and all other forms of media. I also hereby release the Orange Board 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: _______________ Address of Parent/Guardian: ___________________
OR
Signature of Student (if 18 or over): ____________________________________ Date: __________________ Address of Student: __________________________