Student Release Form for Media Materials


Date_______________

Dear Parent/Guardian:

As a first year teacher in North Carolina, I am required to complete a professional portfolio.  This portfolio will contain video-taped lessons that I teach in the classroom, photographs of students at work, finished student work and/or audiotape of student/teacher conversations.  There may be occasions in which I will need to copy (photocopy, scan, videotape or photograph) student work.

The portfolio I create will be reviewed by my professionally mentor, principal and county school board.  Please indicate below if it is permissible to include your child on videotape, in photographs and/or on audiotape.

Please return this to me by_________________.

Thank you for your cooperation and assistance!

Sincerely,
 
 
 

Ms. Carroll

________________________________________________________________________________________________

Student:___________________________________________

Please check one :

_____YES, my child may be videotaped, audiotaped or photographed.

_____NO, my child may not be videotaped, audiotaped or photographed.
 

Parent/Guardian signature:_________________________________Date_____________