Parent/Guardian Consent Form
This
form is to both inform you and to request permission for your child’s
photo/image/video and personally identifiable information to be published on
the district and/or school’s website.
As you are aware, there are potential dangers
associated with the posting of personally identifiable information on a website
since global access to the Internet does not allow us to control who may access
such information. These dangers have always
existed; however, we as schools do want to celebrate your child and his/her
work. The law requires that we ask for
your permission to use information about your child.
Pursuant to law, we will not
release any personally identifiable information without prior written consent
from you as parent or guardian.
Personally identifiable information includes student names, photo or
image and work samples.
If you, as the parent or
guardian, wish to rescind this agreement, you may do so at any time in writing
by sending a letter to the principal of your child’s school and such rescission
will take effect upon receipt by the school.
Please check one of the following:
I/We GRANT
permission for my child listed below to have his/her pictures, video, name
and/or work to appear on the Cliffside Park School District Website, and hereby
release
I /We DO NOT
give permission for pictures, name and/or work of my child to appear on the
Cliffside Park School District Website.
Student Name:
____________________________________________________
Grade: _______________________ Teacher: ________________________
School: __________________________
Parent/Guardian Name:________________________________________________
Parent/Guardian Signature:
____________________________________________