Press Release/Website Consent Form

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We are sending you this parental/guardian consent form to both inform you and to request your permission to use your child’s photo/image and personal information on our district’s website, in press releases that are published in our school and local newspapers, and on our school television programs.

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’s work and achievements by publicizing them. The law requires that we ask for your permission to use information about your child, but we do NOT release such personal information as residential addresses, phone numbers, email addresses, locations of classes or field trips etc.

Please check only ONE Option: *

Option 1: We grant permission for this student’s name, photo and some information about the activity or event in which your child has participated or has been honored to be published on the school’s/district’s website, in school and local newspapers, and used in the school’s television productions on cable television.

Option 2: I/We DO NOT grant permission for this student’s name, photo and some information about the activity or event in which your child has participated or has been honored to be published on the school’s/district’s website, in school and local newspapers, and used in the school’s television productions on cable television.

Student First Name *

Student Last Name *

Homeroom Teacher

Grade *

Kindergarten

1st grade

2nd grade

3rd grade

4th grade

5th grade

6th grade

7th grade

8th grade

Parent/Guardian First Name *

Parent/Guardian Last Name *

Relationship to Student *

Email Address *

Date *

YYYY

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