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Media Release & Photo Consent

Permission for use of photographs and media

📋 Participant Information

Student Name:

Parent/Guardian Name:

Date:

📸 Purpose of Media Use

I, , may occasionally take photographs, videos, or other media during tutoring sessions or related educational activities for the following purposes:

• Showcasing tutoring services on website and social media

• Marketing materials (flyers, brochures, advertisements)

• Portfolio and testimonial displays

• Educational progress documentation

✅ Consent Options

Please select the applicable option:

⚖️ Terms

• This consent may be revoked at any time by providing written notice to the tutor.

• All media will be used in a respectful and professional manner.

• No full names will be published alongside media without additional written consent.

• The tutor will make reasonable efforts to remove media upon revocation of consent.

✍️ Signatures

Parent/Guardian Signature
Date
Tutor Signature
Date