Consent and Release Form
Authorization to Photograph or Record
Student for Public Performance
I, ____________________, am the lawful parent or guardian of
______________________, presently a student at Diplomat Elementary School and a minor. I hereby grant permission for my child to be photographed and/or recorded in connection with any and all school activities. I understand the photographs and/or media productions in which my child may be a participant may be used for purposes including but not limited to public service announcements, school publicity, and other programs shown to the general public. I understand that my execution of this Authorization serves as a waiver of privacy rights otherwise available pursuant to the Section 228.093, Florida Statutes, or other applicable law, with respect to the above described event(s).
________________________________ ____________________
signature of parent or guardian
date
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Last Modified:
10/06/05