Photo/Image/Video Release Form
Everett Public Schools (EPS) is committed to providing leadership and cooperative services to its educational communities in support of their efforts to increase the number of students meeting state and local standards. To achieve this, Everett Public Schools sometimes uses photographs and/or recordings of participants. Your cooperation and consent in permitting Everett Public Schools to use images of you in various mediums is appreciated. You have the EPS’s assurance these images will be used only for official purposes.
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I, , grant permission to Everett Public Schools to use any photographic/video image(s) taken of me, or of anyone for whom I have legal responsibility, for any official publication, presentation, exhibit, video, or other print/digital format. This permission is provided voluntarily and without compensation or restriction regarding use. I further grant to Everett Public Schools full rights to republish, without time restriction, these images in official Everett Public Schools publications and reports. I further extend my permission to Everett Public Schools to provide these images to the media as part of any official Everett Public Schools business.
Everett Public Schools representative: Title: Event at which images taken:
Date:
(Printed Name)
(Signature) (date)
If granting permission to persons under 18 years of age print their name(s) below]:
Witness:
[Required if granting permission for minor(s)]
(Printed Name)
Completed form to be filed at:
Everett Public Schools 3900 Broadway Everett, WA 98201 Voice: 425-385-4040 FAX: 425-385-4012
Web: www.everettsd.org For more information: (425) 385-4040 (Signature) (date)