PHOTO RELEASE FORM

Please fill out one form for each child.

During the duration of the HELP Program (also known as GRACE - Millen), we will take photographs and videos of activities involving students to share on our social media platforms and website.

Some photographs/videos may capture your child’s participation, directly or indirectly.

With your permission, captions associated with photographs and videos may include your child’s first name (or nickname) and birthday (when applicable).

Your signature below gives your consent in allowing us to publish photos or videos which may include your child to the said digital platforms.

Please fill out completely.

Student's Full Name (first & last)

Parent/Guardian's Full Name (first & last)

Parent/Guardian Email

Parent/Guardian Phone

Student's Nickname (what do they like to be called)?

Date of Birth (list only what you will allow to be used - for example, if you only want the month and day posted write April 18 (without the year). If you do not want your child's birthday to be used, please write N/A.

Please Select One of the Following:

I give permission for HELP: GRACE - Millen to use social media posts containing my child.

I do NOT give permission for HELP: GRACE - Millen to use social media posts contain my child.

PHOTO RELEASE FORM

Please fill out one form for each child.

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