Media Release Form 2021-2022

We will possibly be using your child’s photograph, voice, and/or name in various media projects. Please sign this form with your choice related to media consent.
Name of child or children enrolled for 2021-2022:*
Please Select:*
- YES, I grant permission for my child(ren) to participate and appear in photographs for internal Northstar use (class webpages, school newsletters, etc.)
- NO, I do not consent to use of my child’s/childrens' photograph, voice and/or name in various media projects.
Date*
Date Format: MM slash DD slash YYYY
Parent Name*
First Last
Parent Signature*