LA DKDA PHOTO RELEASE AND
CONSENT FORM
I understand the importance of using images and sound
recordings of LA DKDA activities in printed materials, LA DKDA website, videos,
and television broadcasts. Therefore, I give permission for LA DKDA and their
affiliates to use photographs, video recordings, and voice recordings of my child
____________________________ age eighteen and under for whom I have legal
guardianship. This consent includes the storage, retrieval, and reproduction of
information or images. Photographs, videos, audio recordings and the tapes,
negatives, and digital media from which images and sound recordings are made
shall be the property of LA DKDA, which shall have the right to publish,
reproduce, distribute, and make other uses free of all claims on my part.
Printed Name of Adult:
__________________________________
Signature of Adult:
_____________________________________
Date: _____________________, 200__
Street Address:
________________________________________
City, State, Zip Code:
____________________________________
Phone Number: daytime (___) ________________
evening (___) ________________
Email Address:
_________________________________________
Printed Name of student:
______________________________ Age of
student: _____
(This form can be used for any event and does
not expire.)