2019-2020 Photo, Press, Audio, and Electronic Media Release for Minors

One form per student must be completed.

Student's Last Name: *

Student's First Name: *

The Office of Catholic Schools of the Diocese of Arlington (OCS) and any of its schools and/or the Arlington Catholic Herald may produce or participate in video taping, audio recording, website or still photographic productions that may involve the use of students' names, likenesses, or voices. Such productions may be used for educational and/or official school marketing purposes and may be copied or copy-righted with the school retaining any and all rights to such productions.

Keep in mind that this also includes photographs, video, or audio, such as those taken on field trips and during typical school activities. If you provide your permission, these may be used for school/diocesan marketing materials as well as end of the year video montages and other school based productions.

You have the right to prohibit the use of your child's name, while still giving permission for the use of his/her picture and/or voice in these productions. Please read the options below carefully as you consider your decision and sign this form. This agreement is binding for the 2019-2020 school year. No adaptations, changes or alterations may be made for the 2019-2020 academic year. Please sign this form reflecting your decision.

Image and Audio: *

I DO grant permission for my child (named above) to be photographed or featured in any videotape, television, audio recording, or broadcast that will be produced and made available to the public from the Catholic Diocese of Arlington, its parishes, its schools and/or the Arlington Catholic Herald, or (to the extent that access is within OCS's control during school hours) to the media.

I DO NOT grant permission for my child (named above) to be photographed or featured in any videotape, television, audio recording, or broadcast that will be produced and made available to the pubic from the Catholic Diocese of Arlington, its parishes, its schools and/or the Arlington Catholic Herald, or (to the extent that access is within OCS's control during school hours) to the media.

Identity: *

I DO authorize the Catholic Diocese of Arlington, its parishes, its schools and/or the Arlington Catholic Herald to use MY CHILD'S NAME identifying them in photographs, videos and/or recordings for news stories, educational, illustration and/or marketing purposes.

I DO NOT authorize the Catholic Diocese of Arlington, its parishes, its schools and/or the Arlington Catholic Herald to use MY CHILD'S NAME identifying them in photographs, videos and/or audio recordings for new stories, educational, illustration and/or marketing purposes.

Yearbook Only Permission: *

I DO grant permission for my child to be photographed for the school yearbook and/or in a classroom photograph.

I DO NOT grant permission for my child to be photographed for the school yearbook and/or in a classroom photograph.

I agree and understand: *

that my typed signature below shall have the same legal effect as my original signature and is being accepted as my signature pursuant to the Virginia Uniform Electronic Transactions Act, code of Virginia, 59.1-479 et seq.

Signatures for both parents/guardians must be entered. Enter "Not Applicable" in the second signature block if only one parent/guardian exists.

Electronic Signature of Parent/Guardian:

clear

Electronic Signature of Parent/Guardian:

clear

Date: * +