Date: __________

Dear Parent/Guardian:
I am a student at Appalachian State University, and I am working in your child's class as an intern.    As a part of my class work, 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.
My professors at Appalachian State University who will handle the material confidentially will review any products I create.  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, audio taped or photographed.
_____No, my child may not be videotaped, audio taped or photographed.
 
 
Parent/guardian signature: _______________________________           Date: _______