[school name / school board name] Model Release Form

I hereby consent that the still or moving images and/or audio recordings taken of me by [school name] in the [school board name], may be used by the [school / school board] for the purpose of illustration, promotion, publication or broadcast, in any manner and on any number of occasions, in support of its programs and goals.  

SIGNED:		
NAME (Please Print): 		
ADDRESS: 		

COUNTERSIGNED BY PARENT/ GUARDIAN (in the case of a minor under 18 years of age): 

DATE: 		

PROJECT: 		

[SCHOOL/SCHOOL BOARD] STAFF:

**Any release proposed by a school or Board must be vetted by Board legal advisors before use