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Ascension School - REQUIRED Media Authorization Form

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

For marketing and publicity purposes, there may be times when the archdiocese wishes to use your and/ or your child(ren)'s image, name, recording, or academic work in various media for marketing and/ or publicity purposes. You may choose the appropriate level(s) of authorization. For your convenience, this one form covers all members of your family on one form.

ARCHDIOCESE OF ST. LOUIS - I grant permission to use my or my child(ren)'s image, name, recording, or academic work in communications that include, but are not limited to, asrchstl.org, St. Louis Review, Catholic St. Louis magazine, archdiocesan social media, and any publication(s) by agencies administered by the Archdiocese of St. Louis.*

Answer required for "ARCHDIOCESE OF ST. LOUIS - I grant permission to use my or my child(ren)'s image, name, recording, or academic work in communications that include, but are not limited to, asrchstl.org, St. Louis Review, Catholic St. Louis magazine, archdiocesan social media, and any publication(s) by agencies administered by the Archdiocese of St. Louis."

Yes

PARISH/ SCHOOL - I grant permission to use my or my child(ren)'s image, name, recording, or academic work in communications that include, but are not limited to, parish bulletin, school newsletter, student newspaper, admissions videos, parish/ school website and social media.*

Answer required for "PARISH/ SCHOOL - I grant permission to use my or my child(ren)'s image, name, recording, or academic work in communications that include, but are not limited to, parish bulletin, school newsletter, student newspaper, admissions videos, parish/ school website and social media."

Yes

SPONSORING ORGANIZATIONS - I grant permission to use my or my child(ren)'s image, name, recording, or academic work in websites, videos, and publications created by independent foundations and corporations that support Catholic education but are not legally connected to the Archdiocese of St. Louis, including, but not limited to, Today and Tomorrow Educational Foundation, Roman Catholic Foundation of Eastern Missouri, Access Academies, English Tutoring Project, and United Way. *

Answer required for "SPONSORING ORGANIZATIONS - I grant permission to use my or my child(ren)'s image, name, recording, or academic work in websites, videos, and publications created by independent foundations and corporations that support Catholic education but are not legally connected to the Archdiocese of St. Louis, including, but not limited to, Today and Tomorrow Educational Foundation, Roman Catholic Foundation of Eastern Missouri, Access Academies, English Tutoring Project, and United Way. "

Yes

SOCIAL MEDIA OUTLETS - I grant permission to use my or my child(ren)'s image, name, recording, or academic work in secular media communications including, but not limited to, print, radio, TV, and internet. (Examples: St. Louis Post Dispatch, KMOX radio, KSDK-TV).*

Answer required for "SOCIAL MEDIA OUTLETS - I grant permission to use my or my child(ren)'s image, name, recording, or academic work in secular media communications including, but not limited to, print, radio, TV, and internet. (Examples: St. Louis Post Dispatch, KMOX radio, KSDK-TV)."

Yes

Authorization

Parent/ Guardian Full Name:*

Answer required for "Parent/ Guardian Full Name:"

Parent/ Guardian Phone Number:*

Answer required for "Parent/ Guardian Phone Number:"

Parent/ Guardian Email Address:*

Answer required for "Parent/ Guardian Email Address:"

School Name:*

Answer required for "School Name:"

Parish (if applicable):*

Answer required for "Parish (if applicable):"

Child 1 - Name / Grade / Age*

Answer required for "Child 1 - Name / Grade / Age"

Child 2 - Name / Grade / Age:

Answer required for "Child 2 - Name / Grade / Age:"

Child 3 - Name / Grade / Age:

Answer required for "Child 3 - Name / Grade / Age:"

Child 4 - Name / Grade / Age:

Answer required for "Child 4 - Name / Grade / Age:"

Parent/ Guardian Signature:*

Signature Required

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"