CLSC Photo Release Form

美康中文学校
Chinese Language School of Connecticut
P.O. Box 515, Riverside, CT 06878-0515
(866) 301-4906
www.ChineseLanguageSchool.org

Permission to Use Student’s Photograph

During the course of the academic year, Chinese Language School of CT may wish to use photographs of CLSC Students on school bulletin boards, in educational publications or in general media releases on a controlled basis. Any such photographs would highlight the student(s) either demonstrating learning techniques or participating in approved school activities.

In accordance with school policy, names of individual students will not be released with any photographs.

Student’s Name: _____________________________________________________

____ I/We consent to the use of my child’s image; such use may include all CLSC Publications (print, online, video, etc.) and/or general media releases. Such photographs would highlight the students either demonstrating learning techniques or participating in approved school activities.

____ I/We DO NOT consent to the use of my child’s image ever; this use includes all CLSC Publications (print, online, video, etc.) and/or any general media release.

Parent’s/guardian’s signature __________________________Date _______

Parent’s/guardian’s signature __________________________  Date _______

Email address _______________________________________________________

The Chinese Language School of Connecticut is accredited by AdvancED.

School of Connecticut (CLSC) is a not-for-profit 501 (C) (3) tax exempt organization

The Chinese Language School of Connecticut is accredited by AdvancED.

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