Student Release Form for Media Activities

Date: _______________

Dear Parent/Guardian:

As a part of our curriculum this year, I will be shooting videotape, taking photos, or audiotaping in the classroom. This practice is often helpful in the lessons and provides visual or auditory references for both the students and myself.

Any products I create will be handled confidentially. Please indicate below if you grant your permission for the inclusion of your child in these activities and return it to me by

_____________________

Thank you for your cooperation and assistance in this matter.

Sincerely,

Student Name: ______________________

Check appropriate response:

___ Yes, my child may participate in these activities.

___ No, my child may not participate in these activities.

Parent/Guardian signature: ___________________________