Student Release Form for Media Materials

Date:__________

Dear Parent/Guardian:

As your child’s teacher I may be required to shoot videotape, take photos, or audiotape in the classroom. I may also copy (photocopy, scan, videotape or photograph) student work.

Any products I create will be reviewed by my supervisors who will handle the material confidentially. Please indicate below if it is permissible to include your child on videotape, in photographs and/or on audiotape, and return this to me by __________________________.

Also, our school computers have capability of using the Internet. This permission slip also grants your student to use the Internet for research when necessary. Please note if this is a problem for your student.

Thank you for your cooperation and assistance.

Sincerely,

Student Name:_______________________________________

Check appropriate response:

_____Yes, my child may be videotaped, audiotaped or photographed and can have access to the Internet.

_____No, my child may not be videotaped, audiotaped or photographed

and may not use the Internet.