Permission to Photograph

I, ________________________, give permission for ________________________ to

   (Parent or Guardian name)                                                                                           (Child Care Provider)

photograph my child, ________________________, for the following purposes:

                                                      (Child’s name)

Type of Use:

(Please check one)

Grant Permission

Decline Permission

Still Photographs:

Display in my personal scrapbook

Give photographs possibly containing your child to current clients

Display in facility’s scrapbook or bulletin boards, shown to current and prospective clients

Display still photos on child care website*

Post photos on child care’s Facebook page

Other:

Videos:

Give video to current parents

YouTube™ promotional video

Other:

Other (please list):

*Only first names and possibly last initials (in the event of two or more children with the same first name) will be displayed on the facility website.

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.

Signed:

_____________________________________________                  ________________

(Parent or Guardian signature)                                                                           (Date)