Release Form for Use of Student's Name, Picture, or Materials for Publication, Broadcast, Pen-Pal Exchange, Web Site Posting and Class Projects
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Dear Parent/Guardian:
Your child's picture, name or work may be used in one of the following ways:

Posted to the school system or school website on the Internet
Submitted to publishers for publication
Shared with other students in pen-pal projects
Broadcast on television, radio, newspapers, and district social media.
Used in a demonstration project to be presented at conferences or workshops.
Published in the school yearbook
I understand that directory information will be provided. I agree that Johnston County Public Schools, as well as those whose use of the publication, broadcast, pen-pal exchange, or website is authorized by the schools, shall not be held liable for such use, display, on website, conference, or publication.  I also understand that the Family Education Rights and Privacy Act, 20 U.S.C.s 1232 g, prohibits the disclosure of any confidential education record regarding my child without my written consent.
Permission is hereby granted for news photographers or videographers to photograph or record my child during the school day and at school-related activities for the expressed purpose of publication and broadcast.  Permission is also granted for my child's work or picture to be published on the Internet and shown at conferences. Student work will appear with the student's first name and last name; no home address or telephone number will appear with the work.
Student First Name *
Student Last Name *
School Name *
Grade *
Parent/Guardian Name *
Clicking yes in lieu of my signature below indicates permission is granted. A lack of a signature indicates permission is not granted. *
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