Student and/or Parent Photo/Video Consent Form I give permission to the Hispanic Community Affairs Council to take photos of or film me or my child for use in educational and promotional materials, including brochures, public service announcements, websites, reports and other printed and multimedia productions. I also agree to allow the Hispanic Community Affairs Council to use my or my child’s name, likeness or biographical ownership and publication, including any claim for compensation related to use of materials. Student’s Name (Please Print) Student’s Signature Date Contact Phone Information___________________________________ ☐ I consent to take photographs and / or video of me. I do not consent to take photographs and / or video of me. ☐ (Student) I verify that I am at least 18 years of age. ☐ ☐ Yes No (If no, see below.) (Parent or Guardian) Complete below if student is less than 18 years of age. Name of Parent or Guardian (Please Print) Signature of Parent or Guardian Date Contact Phone Information___________________________________ To contact the Hispanic Community Affairs Council go to:
Student and/or Parent Photo/Video Consent Form I give permission to the Hispanic Community Affairs Council to take photos of or film me or my child for use in educational and promotional materials, including brochures, public service announcements, websites, reports and other printed and multimedia productions. I also agree to allow the Hispanic Community Affairs Council to use my or my child’s name, likeness or biographical ownership and publication, including any claim for compensation related to use of materials. Student’s Name (Please Print) Student’s Signature Date Contact Phone Information___________________________________ ☐ I consent to take photographs and / or video of me. ☐ I do not consent to take photographs and / or video of me. (Student) I verify that I am at least 18 years of age. ☐ Yes ☐ No (If no, see below.) (Parent or Guardian) Complete below if student is less than 18 years of age. Name of Parent or Guardian (Please Print) Signature of Parent or Guardian Date Contact Phone Information___________________________________ To contact the Hispanic Community Affairs Council go to: