After School Program

AFTER SCHOOL registration form

AFTER SCHOOL MEDIA RELEASE consent FORM

This Media Release Consent Form will authorize Ms. Dee’s Private Teaching & Tutoring to use and print photographs and any other form of media material for educational, informational, and promotional purposes. Images may be used, but are not limited to, Ms. Dee’s Private Teaching & Tutoring publications and newsletters, Instagram (@ms.dees_teaching), Facebook (Ms. Dee’s Private Teaching & Tutoring), advertising material, web listings, websites, etc. This Media Release Consent Form will be kept on file by Ms. Dee’s Private Teaching & Tutoring as reference for individual approval. After reading the explanation above, I authorize Ms. Dee’s Private Teaching & Tutoring to take and use any photographs or media in any Ms. Dee’s Private Teaching & Tutoring publication, production, or presentation, including electronic internet marketing material for the purpose of promoting Ms. Dee’s Private Teaching & Tutoring in a positive manner.

Do you give consent? Please respond with YES or NO*

Parent's Full Name*

Student's Full Name*

Date*

Parent Email*

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