Parental Consent Form for the Use of Photographs and Videos

Document to be completed and signed by the holder(s) of parental authority. It allows you to grant or refuse, freely and on an informed basis, the capture and publication of your child’s image.

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1. Organisation (data controller)

• Organisation name: [ORGANISATION NAME]
• Address: [FULL ADDRESS OF THE ORGANISATION]
• Type: [SCHOOL / DAYCARE / MULTI-CARE FACILITY]
• Organisation representative: [NAME AND ROLE]
• Contact: [PHONE] — [EMAIL ADDRESS]

State the full identity and contact details of the organisation, which acts as the data controller for the images.

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2. Data Protection Officer (DPO), if applicable

• Name or department: [DPO NAME OR DEPARTMENT]
• Contact: [DPO EMAIL OR POSTAL ADDRESS]

To be completed only if a Data Protection Officer has been designated. Otherwise, indicate the contact responsible for data protection matters.

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3. Child’s identity

• Surname: [CHILD’S SURNAME]
• First name: [CHILD’S FIRST NAME]
• Date of birth: [DD/MM/YYYY]
• Class or group: [CLASS / GROUP / SECTION]

The authorisation is specific to a named child. State the class or care group precisely.

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4. Identity of the holder(s) of parental authority

First holder

• Surname and first name: [SURNAME AND FIRST NAME]
• Relationship to the child: [FATHER / MOTHER / LEGAL GUARDIAN / OTHER]
• Contact details: [PHONE / EMAIL]

Second holder (if applicable)

• Surname and first name: [SURNAME AND FIRST NAME]
• Relationship to the child: [FATHER / MOTHER / LEGAL GUARDIAN / OTHER]
• Contact details: [PHONE / EMAIL]

Only the holders of parental authority may give consent. When parental authority is exercised jointly, the signature of both holders is recommended.

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5. Purpose

The organisation wishes to capture and use photographs and/or videos of the child in the following context: [DESCRIPTION OF THE PURPOSE — e.g. promoting school life and educational activities].

Clearly describe the intended objective. The images will not be put to any commercial use.

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6. Authorisation to capture (taking images)

Capturing and publishing are two distinct acts: each is the subject of a separate choice below.

I authorise the organisation to photograph and/or film my child within the activities described:

• I authorise
• I do not authorise

Tick one box only. This first choice concerns only the taking of images, independently of any publication. If you tick “I do not authorise”, section 7 (publication) does not apply.

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7. Authorisation to publish (by channel)

For each channel below, indicate your choice. Publication will only take place on the channels expressly authorised.

Publication channel	I authorise	I do not authorise
Organisation website — [WEBSITE URL]	[ ]	[ ]
Organisation social media — [ACCOUNT/NETWORK NAMES]	[ ]	[ ]
Newsletter / information bulletin	[ ]	[ ]
Internal display on the premises	[ ]	[ ]
Intranet / digital space reserved for families	[ ]	[ ]
Local or regional press	[ ]	[ ]

Intended geographical scope of publication: [RESERVED INTRANET / PUBLIC INTERNET / PRESS]

Tick one box per row. A general or permanent authorisation is not sufficient: specify each channel. You may authorise only certain channels.

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8. Period of validity

This authorisation is valid for the following period: from [START DATE] to [END DATE] (generally the current school year).

State the start and end dates. The authorisation is neither general nor permanent and must be renewed.

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9. Retention of the images

The photographs and videos will be retained for: [RETENTION PERIOD], then deleted. Any archiving beyond this period is carried out only where justified by a legal obligation.

Specify how long the organisation will retain the images.

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10. Freedom of consent and right of withdrawal

• Your consent is freely given: a refusal, whether total or partial, has no negative consequence for the child, either in their schooling or their care.
• You may withdraw your consent at any time, for all or some of the channels, by sending a request to: [CONTACT FOR WITHDRAWAL — email or address]. Withdrawal does not apply to publications already carried out before it is taken into account.

Indicate the contact to whom a withdrawal request should be sent.

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11. Your rights (GDPR)

A photograph or video that makes it possible to identify your child constitutes personal data. You have a right of access, rectification, erasure and objection regarding this data.

• To exercise these rights: [CONTACT FOR EXERCISING RIGHTS]
• You also have the right to lodge a complaint with the CNIL (www.cnil.fr).
• For more information, consult the organisation’s privacy notice: [REFERENCE OR LINK TO THE PRIVACY NOTICE]

Provide the dedicated contact and the link to the full privacy policy.

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12. Important reminders

• An image published online may be copied, shared or re-published by third parties, beyond the organisation’s control.
• The organisation undertakes not to authorise the commercial re-publication or re-sharing of the images.
• A separate authorisation may be requested for a one-off event not covered by this form.

Informational section — no information to complete.

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13. Signatures

Done at [PLACE], on [DATE].

• Signature of the first holder of parental authority: ________________________
• Signature of the second holder of parental authority (if applicable): ________________________
• Signature of the child, if old enough to understand (recommended, optional): ________________________

The date and handwritten signature of the holders of parental authority are essential. Seeking the child’s opinion and signature when they are old enough to understand is good practice, with no fixed age requirement.

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How to use this template

• Customise the header with the exact contact details of your organisation and, where applicable, those of the Data Protection Officer, before distributing it to families.
• Provide one form per child and make sure to obtain the signature of all holders of parental authority, particularly when it is exercised jointly.
• Keep a record of the choices channel by channel: only publish an image on the channels expressly ticked “I authorise”.
• Renew the authorisation for each period of validity (generally each school year) — a general or permanent authorisation is not appropriate.
• Keep a register of consent withdrawals and stop the relevant publication as soon as they are received.
• Attach or reference the organisation’s full privacy notice so that families have detailed information about how the images are processed.