Horry County Schools

Parental Permission for Media Coverage

Date: ______________________

Purpose/Event: _____________________________________________________

Your child may be featured in a media presentation on the above referenced event and it may be used in the newspaper, on radio, on television, on the HCS website, or in a publication printed by Horry County Schools.

Please sign the release below and return it to Horry County Schools, 1605 Horry St., Conway, SC 29527, or you may fax it to 843-488-6779.

If you have any questions, please call 488-6776. Thank you for your cooperation.

I give permission for my child’s picture and name to be used in a media presentation.

I give permission for my child’s picture to be used in a media presentation, but do not use his/her name.

__________________________________ _________________________________

Child’s Name Child’s Date of Birth

_________________________________

Parent’s Signature

_________________________________

Date