PHOTO RELEASE AUTHORIZATION

I__________________________________ GIVE PERMISSION TO JUST FOR KIDZ CHILD CARE CENTER

TO PHOTOGRAPH MY CHILD ______________________________________ FOR THE FOLLOWING PURPOSES:

STILL PHOTGRAPHS

______ DISPLAY IN PROVIDERS PERSONAL SCRAPBOOK
______ GIVE PHOTOGRAPHS TO CURRENT CLIENTS
______ DISPLAY IN FACILITIES SCRAPBOOK OR BULLETIN BOARDS, VIEWABLE BY CENTER VISITORS
______ DISPLAY STILL PHOTOS IN FACILITIES WEBSITE
______ USE STILL PHOTOS IN PROMOTIONAL MATERIALS
______ USE ON FACILITIES FACE BOOK PAGE

VIDEOS

_____ GIVE VIDEOS TO CURRENT PARENTS
_____ DISPLAY VIDEO ON FACILITY WEBSITE
_____ USE VIDEOS IN PROMOTIONAL MATERIALS

***ONLY FIRST NAMES AND POSSIBLY LAST INITIALS (IN THE EVENT OF 2 OR MORE CHILDREN WITH THE SAME
NAME) WILL BE DISPLAYED ON THE FACILITY WEBSITE

****ALL CHILDREN AND PARENTS WILL BE RECORDED WITH VIDEO SURVEILLANCE WHILE INSIDE THE FACILITY

**I UNDERSTAND THAT IT IS MY RESPONSIBILITY TO UPDATE THIS FORM IN THE EVENT THAT I NO LONGER WISH TO
AUTHORIZE ONE OR MORE OF THE ABOVE USES. I AGREE THAT THIS FORM WILL REMAIN IN EFFECT DURING THE
TERM OF MY CHILD'S ENROLLMENT. BY SIGNING BELOW, I ALSO AGREE THAT THIS IS A LEGALLY BINDING FORM,
AND PROVIDING FALSE INFORMATION COULD BE GROUNDS FOR TERMINATION OF CHILDCARE SERVICES,
FORFEITURE OF RETAINER OR BOTH.

PARENT/GUARDIAN SIGNATURE __________________________________________________________________DATE____________________