Union Academy Charter School

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Publication Consent Form 2019-2020

Please complete the form below. Required fields marked with an asterisk *
Student's grade:*
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Parent/Guardian's Address: 

State*
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I do hereby grant to Union Academy Charter School the unlimited right to use and/or reproduce photographs, likenesses or the voice of my child in any legal manner and for the internal and external promotional and informational activities of Union Academy Charter School. I also agree to allow my child to be interviewed and/or photographed by representatives of the external news media in relation to any and all coverage of Union Academy Charter School in which they are involved. I also agree to allow my child’s work and/or photograph to be published on Union Academy Charter School’s Internet/Intranet Web Pages, publications, and/or social media pages. I further understand that by signing this release, I waive any and all present, or future compensation rights to the use of the above stated material(s). This release form will be valid as long as my child remains a student at Union Academy Charter School and will be revoked only on my written request. *
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