KISD Student Media Release Form

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Dear Parents/Guardians,

Many opportunities will arise during the course of the school year to showcase the talents and accomplishments of students. Our district is blessed to have a number of outlets including local television stations, our own district-operated cable TV channel, social media channels, district publications and website. Of course, our wish is that all students and their work can be highlighted but we understand that parents might have reservations about their children appearing on some of the outlets available to us. Requests can vary from a photo only to being videotaped and interviewed.

With prior parental permission only, our KISD communications department and other media like to mention the name of students who appear on shows that air and are published in newspapers and magazines. Some of district publications mention students by name, as well.

A printable copy of this form is available upon request.

Student Last Name *

Student First Name *

School ID Number *

Grade *

Teacher *

Parent/Guardian's Name *

Parent Phone Number *

Please select one of the following choices: *

I DO grant permission for still photos, videotape or interviews with my child to be used by the Killeen Independent School District for publications, newspaper and television news (local and national) stories and on the KISD website.

I DO NOT grant permission for still photos, videotape or interviews with my child to be used by the Killeen Independent School District for publications, newspaper and television news (local and national) stories and on the KISD website.

Parent/Guardian: By entering my name below, I state that, as the parent/guardian of the above named student, I agree to indemnify and hold harmless the Killeen Independent School District, its agent, trustees, employees and volunteers from any and all damages, injuries, or causes of action, which may result from the photography of my child or the publication thereof. This serves as my signature. *

Date Signed *

YYYY

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