We are sending you this parental consent
form to both inform you and to request permission for your child’s
photo/image and personally identifiable information to be published
on the district and /or school’s web site.
As you are aware, there are potential dangers associated with the
posting of personally identifiable information on a web site since
global access to the Internet does not allow us to control who may
access such information. These dangers have always existed; however,
we as schools do want to celebrate your child and his/her work. The
law requires that we ask for your permission to use information about
your child.
Pursuant to law, we will not release any personally identifiable information
without prior written consent form you as parent or guardian. Personally
identifiable information includes student names, photo or image, residential
addresses, e-mail address, phone numbers and locations and times of
class trips.
If you, as the parent or guardian,
wish to rescind this agreement, you may do so at any time in writing
by sending a letter to the principal
of your child’s school and such rescission will take effect
upon receipt by the school.
Check one of the following choices:
I/We
GRANT permission for a photo/image that includes
this student without any other personal identifiers to
be published on the school
and/or district’s public Internet
site.
I/We
GRANT permission for this student’s photo/image and name
to be published on the school and/or district’s public
Internet site.
I/We
GRANT permission for this student’s photo/image and all
other personal identifiers listed above to be published on the school
and/or district’s public Internet site.
I/We
DO NOT GRANT permission for photo/image that includes
this student to be published on the school and or district’s
public Internet site.
Student’s Name: (please print) __________________________ Student’s
Grade: ______
This
agreement will remain in effect from year to year unless revoked
by the parent/guardian.
Print name of Parent/Guardian: (print) ________________________________________
Signature
of Parent/Guardian: (sign) _________________________________________
Relation
to Student: _______________________________________________________
Date:
______________________________