Permission for Use of Student Image, Voice, Video, Work and/or First Name for News Media, District Communications, and Educational Purposes
Parents/Guardians, This letter is to request permission (in accordance with Policy 815.1) for your child’s image, voice, video, work and/or first name to be published publicly on a School District website, including District social media pages, or any other public website for news media or for general educational purposes. At times, student images, voices, videos, work and/or first name may be requested to promote or represent the School District, School District programs and/or School District events in the news media including, but not limited to, television, print, and on the web. Student information may be used by credible news media not affiliated with the School District and on School District websites and official School District social media pages (Facebook®, Twitter®, YouTube®, Instagram®).

Student information is also used on the Internet for general educational purposes and to celebrate student work. Websites, applications and Internet resources may collect or require the use of student images, voices, videos, work and/or first name. When these are available publicly, the School District cannot control who can view or share. Accordingly, the School District will not post student images, voices, videos, work and/or first name on a School District website, including District social media pages, or any other public website for news media or educational purposes without prior written consent from you as the parent or legal guardian.

This permission will be applicable to any use of student information in the school year in which permission is given and will remain in effect until removed from the website or until consent is withdrawn. As parent or legal guardian, you may withdraw your consent at any time by sending a written letter, along with a new form, to the Principal of your child’s school. Thank you for your cooperation.
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Email *
Student's Name: *
Grade *
Classroom number
Check the use(s) of your child’s image, video, voice, work, and/or first name that you grant permission for:
*
Required
Parent/Legal Guardian's name (used as signature): *
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