• 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: ___________________


    Signature of Student (if 18 or over): ____________________________________ Date: __________________ Address of Student: __________________________