Photo/Video Permission Consent Form

Please read carefully and fill out the application form, if you wish for photos or videos to be used.

Photo/Video Permission – We at KMA Shotokan Karate have Karate classes that will be using photography or videography as part of their Training. The Bottom portion of this permission slip is for use at KMA Shotokan only for things such as Newspaper, Promotion and Internet publications.

I give my permission for to be photographed or videoed for Newspaper, Promotion and Internet publications.

Internet Publication Consent Form – Below is permission for KMA Shotokan Karate to use photos/videos of your child on our Websites and Promotional Products, of things such as Awards and Karate activities.

Protection of private information on club web sites.

Because internet publications are available to the entire world, special care will be taken to protect the privacy of students and Instructors. No personal information about students or Instructors, such as home addresses and telephone numbers, shall be included on a Newspaper or Internet Publication.

In accordance with the KMA Shotokan Policy, Student Records/Release of Information on Students names and pictures of students shall be included only under the following conditions:

Groups of two or more students involved in an activity may be included, but they shall be identified only with the name of the activity. Permission is not required for large group photos.

Smaller groups of individuals shall only be included if the parent (or student who is of legal age to consent) signs the KMA Shotokan Internet Publication Consent Form.

Student shall not be identified in Photos unless there is a special reason for doing so, such as recognition for receiving an award. In such cases, a parent or guardian (or student who is of legal age to consent) must sign this Internet Publication and Photography Consent Form.

Any persons found using any Photos or Video publications without prior written permission from KMA Shotokan Karate could be liable for prosecution.

One Consent form must be completed and Signed for each KMA Student

Checkbox

If Under 18, please complete the Parent/Guardian and Student section A

If over the age of Concent only complete the Student Section B

Parents/Guardian Name (Student the age of consent) (Section A).

By signing below, the Parent/Guardian and Student(s) acknowledge that they have read and agreed to the terms of this Photography/Videography form.

First Name

Last Name

Students Name (Section A)

First Name

Last Name

Students D.O.B (If under 18 years of age Go To Section A)

D.O.B Format (00/00/0000)

Photo Permission for under 18 Years old (Section A)

As the parent or legal guardian of the above student(s), I give my consent to terms of the internet publication consent form as stated above.

Students Name (Section B)

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email

Phone Number

(###)

###

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