CONSENT TO USE STUDENT WORKS AND IMAGES

This document gives Learning Lab, LLC consent to use works created by the student at Learning Lab, LLC’s facility.

Date

YYYY

Student Name

First Name

Last Name

Parent/Guardian Name:

First Name

Last Name

Parent/Guardian phone number:

(###)

###

####

Parent/Guardian E-mail:

I hereby consent to the use of works and quotes, and the taking of photographs and video clips of the student named above. I also grant to Learning Lab, LLC the right to edit, use, and reuse said products in print, on the internet, and in all other forms of media. I also hereby release Learning Lab, LLC and its employees from all claims, demands, monetary compensation, and liabilities whatsoever in connection with the above. I understand that if the student’s work is to be used, it may be identified by their first name and last initial only. The student’s full last name and address will not be included with the work.

I have read and agree to the terms stated in this consent form

I agree

I disagree