Release and Consent Form

Please print and sign this form.

Release & Consent Agreement

I understand that some student work and student images are confidential under state and federal law. However, I desire to allow my child’s image and/or my child’s work, created while a student at Art in the Vine, to be displayed in public. Therefore, I give my full consent for Art in the Vine to display my child’s or my student-created work (art, photography, video recording, audio recording, written work, verbal statements, or web-based material) or student-identifying content (audio recordings, photographs, and video images that include a student’s voice or image) for Art in the Vine’s instructional, informational, public relations, promotion, and/or publicity purposes.


I understand that this student-created work and/or student-identifying content could appear in Art in the Vine publications, including, but not limited to Face book, Newsletters, news releases or publicity materials (print, audio, or video), in public exhibitions of student work, or on the official Art in the Vine web-site, located at I further understand that my child’s or my student-created work or student-identifying content may be used in subsequent  years, in the discretion of Art in the Vine, and may be rebroadcast, republished or redisplayed by third parties, outside the control of the Art in the Vine. I understand that the Art in the Vine has no control over the republication or rebroadcast of student-created work or student-identifying content by third parties and that the Art in the Vine has no control over images, recordings, statements, or photographs that are recorded by third parties.


I acknowledge that my consent to the above conditions is fully voluntary, given without coercion or duress. I further understand that no monetary consideration is being paid to me for such display or publication. I understand that this consent is binding upon my heirs, successors, assigns, and legal representatives. If I wish to revoke this consent in full, or revoke this consent as to any specific student work or student-identifying content, I understand that I must provide written notice to Art in the Vine, Rebecca Winters, Owner 441 E. Northwest Hwy, Grapevine, TX, 76051.


Student’s Name (printed):________________________________________________________

Age : ____________________________________________________________

Parent/Guardian Name (printed) _______________________________________________________________

Parent/Guardian Signature: _______________________________________________________________

Parent e-mail: _______________________________________________________________

Parent Phone Number: _______________________________________________________________

Date: _______________________________________________________________


This release is created pursuant to Texas Education Code § 26.009 and the federal Family Educational Rights and Privacy Act (“FERPA”), 20 U.S.C. § 1232g. I understand that this release does not create or enhance any rights to privacy or intellectual property beyond those that exist under state and federal law.