Date:__________

Dear Parent/Guardian:

The students in my class are going to be apart and working with media materials.    I will shoot videotape, take photos or audiotape in the classroom.  I may also copy (photocopy, scan,
videotape or photograph) student work.

Any products I create may be reviewed by the principalwho 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 ___________________________.
 

Thank you for your cooperation and assistance.

Sincerely,
 
 
 
 

Student Name:_______________________________________
 

Check appropriate response:

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

Parent/guardian signature:_______________________________           Date: _______