CP&P 26-91
(rev. 7/2010)
DEPARTMENT OF CHILDREN AND FAMILIES
CONSENT OF PARENT OR GUARDIAN TO PHOTOGRAPH,
INTERVIEW AND/OR IDENTIFY CLIENT
I _____________________________________________________ am the parent or
guardian of ____________________________________________________________, a client
of the Department of Children and Families.
I DO / DO NOT (circle one) consent to permit the authorities of the Department of
Children and Families and/or members of the press, to make still or moving pictures of this client
and to reproduce such pictures for general distribution, for use in newspapers, magazines, film
and television and make such use thereof as they desire.
I DO / DO NOT (circle one) consent to the identification of this client by name in the
publication or in film or television.
I DO / DO NOT (circle one) consent to permit the authorities of the Department and/or
members of the press, to interview this client to obtain information or comments to be used in
newspapers, magazines, film or television.
I realize that in consenting to the taking and use of any photograph, to the interview of
and/or to the identification of this client by name, I hereby release and discharge the State of New
Jersey, Department of Children and Families and all its agents and employees from any and all
liability, claims or demands, in law or in equity, that I might have against any of them taken by
reason of such photography or identification, and subsequent use thereof.
Signature:__________________________________________ Date:__________________
This consent was witnessed by:________________________________________________
at ____________________________________