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.

Any products I create will be reviewed by my professors at Appalachian State University who will handle the material confientially.  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 you 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:____________