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Photo Release 21-22

Please complete the form below. Required fields marked with an asterisk *

Media Release Form

Contact Information

Student First Name*

Answer Required

Student Last Name*

Answer Required

School*

Answer Required

Student JCPSNJ email*

Answer Required

Parent email*

Answer Required

Parent Phone*

Number Required

Parent Work Phone

Number Required

Please check each that applies. *

Answer Required

I hereby give my permission for the Jersey City Public Schools to release photographs, videotapes, and/or the name of my child to the media for the 2021-2022 school year.

I give my permission to post my child's photograph, videotape, or name on the District's Facebook page.

No, I do not want my child to be photographed or videotaped.

Only parent and guardians can complete this form. *

Answer Required

I certify that the information provided above is accurate and completed by the student's parent or guardian.

Please type your full name. (electronic signature)*

Answer Required

Confirmation Email

Email Required