Student Release Form

The Department of Health, Physical Education and Athletics will be maintaining a website highlighting Bay Shore’s athletes and sports programs. We would like to post rosters and photographs of our high school athletes. Please sign the consent and release below if you approve of having your child’s name and picture posted. If you have any questions, please call the HPEA Office at 968-1186.

Claude Kasman Judy Cummings

Director of HPEA Assistant Director of HPEA

Consent and Release

I acknowledge that I have read this Consent and Release and fully understand, and intend to be legally bound by its contents.

I hereby irrevocably grant to Bay Shore Schools and its licensees, successors and assigns, my consent and full right to publish, display, reproduce and circulate any photographs.

I hereby irrevocably waive any right that I may have in inspect or approve the materials that may be used by Bay Shore Schools or to be compensated for the use of such materials.

For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby irrevocably release Bay Shore Schools from any and all claims I may at any time have arising out of or related to the production or reproduction of these photographs.

Parent/Guardian Name (Print) Signature

Student Name (Print) Signature

Season Sport

Grade Date

CHECK BOX ONLY IF YOU DO NOT CONSENT □