Gahanna â€“ Jefferson Orchestra Department Publicity Release Form Re: Photographs, Audio, Videotape, Student Quotes, Internet and Broadcast This document certifies that a parent or responsible guardian has given written permission (or not given permission) for photographs, quoted statements, audio or video to be used by the Gahanna-Jefferson Orchestra Department, for the purposes of publication, promotion or achievement.
I give my consent.
I do not give my consent.
Print Studentâ€™s Name
Signature of Student (if 18 or older)
Signature of Parent
______________________________________ Printed Name of Parent or Guardian