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Media Release Form

Please complete the form below. Required fields marked with an asterisk *

MediaRelease2022

Student First Name*

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Student Last Name*

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School *

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Student JCPSNJ email*

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Parent Name *

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Parent Email*

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Parent Phone *

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Please all that apply*

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I hereby give my permission for the Jersey City Public Schools to release photographs, videotapes, and/or the name of my child to the media, on the school and district social media, and district websites for the 2022-2023 school year.

No, I do not want my child to be photographed or videotaped.

I hereby give permission for my child’s writing, artwork to be published in print publications and videotapes produced by his/her teacher, school, or the Jersey City Public School District. These publications may include newspapers, literary magazines, journals, book chapters, and videotapes featuring a variety of student work. My child’s writing and artwork may be entered into school-endorsed competitions.

No, I do not want my child’s writing, artwork to be published in print publications and videotapes produced by his/her teacher, school, or the Jersey City Public School District.

Only parent and guardians can complete this form*

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I certify that the information provided above is accurate and completed by the student's parent or guardian.

Please type your full name (electronic signature)*

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