Date: September 22, 1999

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 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 September 28, 1999.
 

Thank you for your cooperation and assistance.

Sincerely,
 

                 Keith Thomas Silver
 

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: _______