Milestone C Media Release

Student Name *

First Name

Last Name

Parent Name

First Name

Last Name

Release *

I, parent/guardian of the above student, hereby give consent to my child being filmed, interviewed, photographed, or have audio or video recordings made of my child by the media (print, broadcast, and online) and employees, agents, or representatives of Milestone C LLC during the program. I understand that Milestone C intends to use the text or image(s) on its website, as well as other marketing/outreach material including TV and print media advertising. I also understand that the text or image(s) may appear in electronic form on the internet or in other publications outside Milestone C’s control. I agree that I will not hold Milestone C responsible for any harm that may arise from such unauthorized production.

I agree to the above statement