Permission to Record Form
SV Parents and Guardians,
Completion of this form is necessary to grant permission for your children to be recorded for online synchronous instruction via Zoom or Google Meet. Please complete this form for all school-aged children in your household by the end of the day on August 21. Thank you for taking the time to complete this form. Please contact Mr. Billman at
if you have any questions.
Student's Last Name
Student's First Name
Name of Parent/Guardian completing this form
Contact information (phone)
Contact information (email address)
For the 2020-2021 school year, this child will attend:
For the 2020-2021 school year this child will be in this grade
I grant consent for this child to be recorded
I grant consent to record
I do NOT grant consent to record
Parents/Guardians - By initializing below (add initials), I verify the completion of this form for this child.
Do you have additional school aged children?
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This form was created inside of Schuylkill Valley School District.