Inez K. Jones Educational Consulting Parental/Guardian Consent Form


We are sending you this parental consent form to both inform you and to request permission for your student’s photo/image and personally identifiable information to be published on Inez K. Jones Consulting web site.

As you are aware, there are potential dangers associated with the posting of personally identifiable information on a web site since global access to the Internet does not allow us to control who may access such information. These dangers have always existed; however, Inez K. Jones Educational Consulting wants to celebrate your child and his/her work. The law requires that we ask for your permission to use information about your child.

Pursuant to law, we will not release any personally identifiable information without prior written consent from you as parent or guardian. Personally identifiable information includes student names, photo or image, residential addresses, e-mail address, phone numbers. If you, as the parent or guardian, wish to rescind this agreement, you may do so at any time in writing by sending a letter to Inez K. Jones at info@inezkjonesconsulting.com

As the child’s parent or legal guardian, I agree to release and hold harmless INEZ K. JONES CONSULTING, it’s agents, officers, contractors, volunteers and employees from and against any and all claims, demands, actions, complaints, suits or other forms of liability that shall arise out of or by reason of, or be caused by the use of my child’s name, photograph or likeness, voice or creative work(s), on television, radio or motion pictures, or in the print medium, or on the Internet or any other electronic/digital medium.

It is further understood and I do agree that no monies or other consideration in any form, including reimbursement for any expenses incurred by me or my child, will become due to me, my child, our heirs, agents, or assigns at any time because of my child’s participation in any of the above activities or the above-described use of my child’s name, photograph or likeness, voice or creative work(s). Creative works shall include, but not be limited to, essays, resumes and personal statements.

Check one of the following options:
  I/We GRANT permission for this student to have photo(s)/image(s), name, awards, scholarships and grants monies received or awarded to my child published on the Inez K. Jones Consulting public Internet site. I also consent for Inez K. Jones CONSULTING’s use of my child’s name, photograph or likeness, voice or creative work(s) on the Internet, on a CD or any other electronic/digital media or print media.
  I/We GRANT permission for these students to have photo(s)/image(s) and all other personal identifiers listed above published on the Inez K. Jones Consulting public Internet site. I also consent for Inez K. Jones CONSULTING’s use of my child’s name, photograph or likeness, voice or creative work(s) on the Internet, on a CD or any other electronic/digital media or print media.
  I/We DO NOT GRANT permission for photo(s)/image(s) that includes this student to be published on the Inez K. Jones Consulting public Internet site. I do not consent to my child being photographed, video taped, audio taped and/or interviewed by Inez K. Jones CONSULTING. I do not consent for Inez K. Jones CONSULTING to use creative work(s) generated and/or authored by my child on television, radio or motion pictures, or in the print medium, or on the Internet or any other electronic/digital medium.

Student's Name:                         
Student's Grade:                         
Name of Parent/Legal Guardian:    
Initials of Parent/Legal Guardian:   
Relation to Student:                     
Date: