CIS MEDIA RELEASE

I hereby give permission to Corrales International School/CIS PTA/news media to photograph/interview/video my child. It is my understanding that this photograph/interview/video or portions thereof will be used for public view. I agree to participate in media projects without financial remuneration, and I understand that this releases the school/photographer/videographer/recorder from any future claims, as well as from any liability, arising from the use of the said photograph/interview.

I hereby give my consent to all photographs, audio recordings, academic work, and/or video recordings taken of me or my minor child by Corrales International School staff or their designee. I understand that any such photographs, audio recordings, academic work, and/or video recordings become the property of the school and may be used by the school, district, or others with their consent, for educational, instructional, or promotional purposes determined by the school in broadcast and electronic media formats now existing or in the future created.

(Please check one of the options below.)

____ Yes, I give my consent.

____ No, I do not give my consent.

Date: __________Teacher's Name: ________________________________

School's Name: Corrales International School________________________

Student's Name: ______________________________________________ (please print)

Parent's/Guardian's Name: ______________________________________ (please print)

Signature: ____________________________________________________

(parent/guardian signature)

Mailing Address: ______________________________________________

______________________________________________

______________________________________________

Telephone: ___________________________________________________

Email Address: ___________________________________________________