SIS Parental Permission for Publicity/Media Relations

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Authorization for Media and Publication Usage. Parents, this will allow us to use a photograph, videotape clip, audiotape clip, art work, and other class work product by your child on the SIS school and/or District's website, the District calendar, and other District print publications. PLEASE DO ONE FOR EACH CHILD THAT ATTENDS SIS.

Email *

Student Name *

Student Grade *

Student's Homeroom Teacher *

Parent/Guardian name completing this form *

I give my consent to the Pocono Mountain School District to use a photograph, videotape clip, artwork, and other class work produced of/by my child on the district's web site, lobby displays, to use in the district newsletters, the district calendar, and other district print publications. *

This consent is for District use only of photographs, videotapes, and or classwork for display within the district

Yes

I give my consent to Pocono Mountain School District to allow my child to be photographed, videotaped ad interviewed by news media reporters invited to cover school and district activities. *

Example: Students being interviewed by media for award ceremonies, sporting events, and special building assemblies

Yes

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