TeacherWeb

Mrs. Kathy Davis, Business/Info. Technology



Top Divider

 

Media Release Form

Permission Form For MEDIA Coverage Only

 

WILSON COUNTY PUBLIC SCHOOLS

351 Stumpy Lane

Lebanon, Tennessee  37090

(615) 444-3282

 

PARENTAL PERMISSION FOR MEDIA

USE OF STUDENT’S PHOTOGRAPH, LIKENESS, AND/OR VOICE

FOR SCHOOL YEAR _____-_____

 

This form is used to establish formal parental permission for student participation in photographs, audio/videotapes, and interviews by the MEDIA.  Please call your school if you have any questions.

 

GENERAL MEDIA COVERAGE

Throughout the year there may be occasions where there are in-school programs, events, or meetings that are open to the public and where large group photographs or videotapes are made by the media (e.g., a pep rally or a DARE program being publicized by a particular school).  Wilson County Public Schools will assume we have your permission for your child to be in these types of group photographs or videotapes UNLESS YOU NOTIFY YOUR SCHOOL IN WRITING that you do not want your child included in such photographs or videotapes.

 

SPECIFIC MEDIA COVERAGE

In addition to the above situations, on occasion, the public and school sponsored media, with the approval of the building principal, may wish to take photographs or audio/videotapes of students or interview students in a manner that would be individually identifiable to a specific student.  Please indicate below if you agree for your child to be in these specific photographs, audio/videotapes or interviews in newspapers, television, radio, and school web-site pages.

 

I, ________________________, parent or legal guardian of _________________________, hereby ¨ GIVE     ¨ DO NOT GIVE permission to Wilson County Public Schools to allow my child to be specifically photographed, audio/videotaped, or interviewed by the MEDIA, with the approval of the building principal, in any way that would reasonably portray programs or events at the Wilson County Public Schools. I further release the Board of Education of Wilson County, Tennessee, and any of its employees or agents, from any compensation or damages in allowing the media’s use of photographs, audio/videotapes, or interviews of my child. I do further certify that I am of full legal capacity to execute the above authorization and release.

 

Date:______________________

                                                                                    ___________________________________

                                                                                    PARENT/LEGAL GUARDIAN

 

 


Bottom Divider

TeacherWeb
©2009 TeacherWeb, Inc.