Palette Group Consent

This form is for media interviews with students for publications and programs. Parent’s permission must be obtained prior to television, film, video or print publication interviews. This also applies to photographs and footage of students taken for the various media.
I,(Required)
the parent of(Required)
do grant my permission for my son/daughter to appear in an article/photograph/televised news program produced by
Address(Required)
MM slash DD slash YYYY
Time(Required)
:
MM slash DD slash YYYY
Address(Required)