I authorize the camp to use photos, video recordings, audio recordings, and student-created content for educational and promotional purposes.

   

Content Creation Foundation, Inc 

Media Release Form 

Production Title _____________________________ Production Date ___ /___ /___  

1) I, the undersigned, hereby authorize ____________________ to photograph me, take  motion pictures of me, take video footage of me, and/or make electronic sound recordings of  me (herein referred to as photographic or electronic reproductions).  

2) I authorize the use of any such photographic or electronic reproductions of me for any  purpose, including, but not limited to educational and other public media as may be deemed  appropriate by ____________________ (I understand that I may be identifiable from such  photographic or electronic reproduction)  

Agreed and accepted by:  

Print Name Title  

Address _______________________________ City__________________ State_______  Zip_______________ Phone ____________________________________________ Signature ____________________________________ Date __________________ I am signing this form as an individual Yes No  

I am signing this form as a representative of a group, and have full authority to grant release  for this group Yes No  

Name of group ______________________________________  

PARENTAL CONSENT  

I certify that I am the parent or guardian of the individual above, ___________________, a  minor under the age of eighteen years. I hereby agree to assume legal responsibility for his/her  authorizations referred to in this General Media Release.  

____________________________________ Signature of Applicant’s Parent/Guardian  ____________________________________ Address of Parent/Guardian (if different)  ____________________________________ City, State, Zip Code  

________________ Date (_____)___________________

Phone Number (if different) 

www.SchillerProductions.com