Child Photo and Video Participation Waiver

If you would like your child to appear in Senate photos or videos, please read, download and sign the waiver below. The completed waiver should be returned to the appropriate Senator's office.

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I grant consent for my child, ____________________, to have his or her picture taken or to be 

filmed with a New York State Senator or group of Senators.  


I authorize any Senator(s) and/or the New York State Senate to publish such picture or video 

footage on any such Senator’s official Senate website and/or any official electronic or paper 

publication of such Senator or the Senate.  This consent is not revocable.   


This consent shall not allow any further publication or broadcast of such picture or video footage 

by any other party, or in any other location or format (e.g. campaign materials, social networking 

websites, etc.) without my advance written authorization.   




__________________________   __________________________ 

Signature of Parent/Guardian    Date 



Printed Name 



*Please return signed waivers to the appropriate Senator at his or her office. 

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