Permission to have picture posted to our school website.
St. Landry Parish School System Publications, Video, Internet Consent and Release Agreement

Students who attend school in St. Landry Parish School System are occasionally asked to be a part of school and/or district publicity, publications and/or public relations activities. In order to guarantee student privacy and ensure your agreement for your student to participate, the district asks that you fill out this form and return it to the school for each of your students.

The form referenced below indicates approval for the student's name, picture, work, voice, verbal statements or portraits (video or still) to appear in school publicity or district publications, videos, or on the district's website. For example, pictures and articles about school activities may appear in local newspapers, school websites, or district publications. These pictures and articles may or may not personally identify the student. The pictures and/or videos may be used by the district in subsequent years.

Student and Parent/Guardian release to St. Landry Parish School Board the student's name, picture, work, voice, verbal statements, and portraits (video or still) and consent to their use by St. Landry Parish School System.
St. Landry Parish School District agrees that the student's name, work, voice, verbal statements, portraits or picture (video or still) shall only be used for public relations, public information, school or district promotion, publicity, and instruction.

Student and Parent/Guardian understand and agree that:

No monetary consideration shall be paid.
Consent and release have been given without coercion or duress.
This agreement is binding upon heirs and/or future legal representatives.
The photo, video, or student statements may be used in subsequent years.

If the student and parent/guardian wish to rescind this agreement they may do so at any time with written notice.

Effective date of agreement: 10/28/2016

Student's Name *
Your answer
Parent/Guardian Name *
Your answer
Teacher Name *
Your answer
Grade *
Do you give permission for your child's work, voice, verbal statements, portraits or picture (video or still) to be included on the school or district website? *
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