• St. Brendan School

  2022 - 2023
  MEDIA AUTHORIZATION AND RELEASE
  Due Sept 20, 2022

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  •      I hereby consent to the taking of photographs, movies, videos, and images capable of reproduction in any medium of me or my children or children of whom I am the designated guardian
     

    I Agree Please select this field.
  • Parent / Guardian
  • First Name REQUIRED Please fill out this field. Please enter valid data.

    Last Name REQUIRED Please fill out this field. Please enter valid data.
  • by the Department of Education, Archdiocese of New York and/or the Catholic School Region and their parents, affiliates, trustees, directors, members, officers, employees, volunteers, agents and contractors (the “School”).
    
              I hereby grant to School the right to edit, reproduce, use and reuse images for any and all purposes including, but not limited to, advertising, promotion and display, and I hereby consent to the editing, reproduction, use and re-use of said images in any and all media in existence and all media yet in existence including, but not limited to, video, print, television, internet, and podcasts.
    
              I forever grant, assign, and transfer to School any right, title and interest that I and/or my child/children may have in any images, including negatives, taken of me and/or my children by School.  I hereby agree to release, indemnify and hold harmless School from any and all claims, demands, actions or causes of actions, loss, liability, damage or cost arising from this authorization.
     
  • Student's Name
  • First Name REQUIRED Please fill out this field. Please enter valid data.

    Last Name REQUIRED Please fill out this field. Please enter valid data.
  • Grade REQUIRED (Select One) PreK K 1st 2nd 3rd 4th 5th 6th 7th 8th Please fill out this field.
  • First Name REQUIRED Please fill out this field. Please enter valid data.

    Last Name REQUIRED Please fill out this field. Please enter valid data.
  • Grade REQUIRED (Select One) PreK K 1st 2nd 3rd 4th 5th 6th 7th 8th Please fill out this field.

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