Media Consent Form

Arizona State Schools for the Deaf and the Blind (ASDB) is proud to celebrate the students’ accomplishments within our community. Accordingly, we may periodically exhibit photos, videos, recordings and other likenesses of our students on our social media platforms, school websites or press releases to the media. Our intent is to be informative and recognize our student’s achievements.

If you AGREE to allow ASDB agency to publish, post or distribute your student’s name, photo/image, likeness, work and/or other information related to their achievements (e.g. academic, athletic, award, events) check the FIRST BOX below.

However, if you DO NOT AGREE to allow ASDB agency to publish, post, print or distribute your child’s name/likeness/image in any way, check the SECOND BOX below.

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I/We AGREE TO GRANT permission for my student’s name and/or photo/image to be published on the school and/or Agency’s public internet site, social media, newspaper, magazine, or other media for publicity and/or recognition purposes, now and in the future.

I/We DO NOT GRANT permission for my student’s name and/or photo/image to be published in any way, now and in the future.

My signature acknowledges I understand this form in its entirety and any changes to my consent shall be made by written request only for future use and is not retroactive on previous use. I further acknowledge my student’s attendance at any event open to the public may have his/her likeness/name/image/photo be used by agency/school/press/publications/media outlets without reasonable expectation of privacy.

Students Name

First Last

Grade

Parent/Guardian Name

First Last

Relation to Student

Date

Signature