Release Form

"*" indicates required fields

Please select Yes or No for each item listed below and sign the form at the bottom.

I give permission for Christ Memorial Preschool to publish the following for class lists. The lists will be given to other preschool families and the preschool staff.*

Yes

Child’s Name*

First Last

Parents’ Name*

First Last

Phone Number*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

I give permission for my child to be photographed, video-taped or filmed without compensation for us at Christ Memorial Preschool. (Posters, Bulletin Boards, Cubbies, Photos Albums, Traveling Books, etc.)*

Yes

I give permission for Christ Memorial Preschool to put pictures of my child on the closed Google Classroom Account. I understand if I do not give permission I will not have access to the account.*

Yes

I give permission for my child’s photograph (no name) to be used on the Preschool website and Facebook page.*

Yes

Signature*

Date*