PHOTOGRAPHIC and/or VIDEO RELEASE FORM

I [print legal guardian name]______________________________________, the Parent or legal guardian of [print minor student name]________________________________ do hereby without reservation; grant permission and give consent to Sky Mountain Charter School, to use any and all pictures of the above named minor student.

I understand that such photographs will be used for publications, SMCS website, and/or exhibits.

Date: _____________

Signature of participant: _______________________________________

Signature of parent/guardian if participant is under the age of 18;

_______________________________________

Family Mailing address: _____________________________________________

Street Address

_____________________________________________

City State Zip code

_____________________________________________

Telephone number

_____________________________________________

e-mail address

Be advised SMCS has no means of controlling the possible copying of this photograph.

It is agreed that the website will not include any reference to any displayed person’ place or residence, telephone number, or any surname.