City of Batavia Spring Traffic Safety Videos 2025

Thank you for helping us make our kids safe.

Please read below and then sign and submit the form after the consent statement prior to our interview with your child.

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Parental Consent for Video Appearance
I, [Parent/Guardian Full Name], as the parent or legal guardian of [Minor Student’s Full Name], hereby grant permission for my child to appear in a video produced by The City of Batavia as part of their 2025 Spring Traffic Safety video series.

I understand that this video may be used for public safety education purposes and may be distributed through various channels, including online platforms, social media, and local media outlets.

I confirm that I have the legal authority to provide this consent on behalf of my child.

By signing below, I acknowledge that I have read and agree to the terms outlined above.

Parent/Guardian Signature:
[Electronic Signature Field Below]
Date:
[When Submitted Below]

• Minor Consent Acceptance

• Parent/Guardian Full Name
  First NameLast Name
• Minor Student’s Full Name
  First NameLast Name
• Signature: I acknowledge that I have read and agree to the terms outlined.
  Clear
• Submit
• Should be Empty: