Authorization and Permission for Photo/Videos: 2020-2021

Authorization and Permission for Photo/Videos: 2020-2021
Please select:*

Marie Philip SchoolWalden SchoolBadavas Parent Infant Program (PIP)Community ASL ClassesOther
If MPS, please select from the following:
I authorize The Learning Center for the Deaf to use a picture or video of myself or my child for the purposes of brochures, newsletters, TLC web page, social media and other media related to the marketing and promotion of TLC, the schools and its activities. When possible, I will be notified of the school’s intentions to use this representation.
Select One:*

YESNO
Name of Student:

First NameLast Name
Parent/Guardian:*

First NameLast Name
Date

MonthDayYear
Date
Should be Empty: