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 audio ape 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 audio tape, 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: __________