Photo Consent/Release Form

Childs Name: __________________________________ Our first priority is to protect your childs health and safety. From time to time we would like to share some of the moments we have preserved on film/camera on the Happy Earth website and/or displaying them within the school or in other publications and advertisements. We will not release any personal information. To ensure that I am operating with your full understanding and agreement, I ask that you grant me permission to conduct the following activities.

Please initial each item for which you consent: ___ Placing photos of your child around my home. ___ Giving copies of photos of your child to other families in my care. ___ Placing photos of your child in photo albums that are viewed by prospective clients . ___ Using photos of your children in my marketing flyers. ___ Using photos of your children on my Web site. ___ Posting artwork and craft activities signed by your child around my home. ___ Including the name of your child and the names of other members of your family in our family newsletter and posting this information on my bulletin board.

Parent/Guardian: ______________________________________________________________ Parent/Guardian Signature: _____________________________________________________ Date: ______________

Happy Earth Playschool, 131 Linda Avenue, Riverhead, NY 11901, 631.779.2643