Parental Guardian Consent Form
We are sending you this parental consent form to both inform you and to request permission for your child’s photo image and personally identifiable information to be published on the district and or school’s web site. As you are aware, there are potential dangers associated with the posting of personally identifiable information on a web site since global access to the Internet does not allow us to control who may access such information. These dangers have always existed: however, we as schools do want to celebrate your child and his/her work. The law requires that we ask for your permission to use information about your child. Pursuant to law, we will not release any personally identifiable information on our web site without prior written consent from you as parent or guardian. Personally identifiable information includes student names, photo or image, residential addresses, e-mail address, phone numbers and locations and times of class trips. If you, as the parent or guardian, wish to rescind this agreement, you may do so at any time in writing by sending a letter to the principal of your child’s school and such rescission will take effect upon receipt by the school. Return this form to Deborah Klipp, MRHS Webmaster, 1301 Oak Avenue, Linwood, NJ 08221 Check one of the following choices:
ٱ _________I/We GRANT permission for this student’s photo/image and name to be published on the school and/or district’s public Internet site.
ٱ _________I/We DO NOT GRANT permission for photo/image that includes this student to be published on the school and or district’s public Internet site.
Student’s Name (please print)_______________________________ Student’s Graduation Year_________
Name of Parent/Guardian: (print) __________________________________
Signature of Parent/Guardian: (sign) ____________________________________
Relation to Student: _______________
Date:_________________
IF YOUR STUDENT'S NAME/PICTURE SHOULD BE LISTED ON ANY CLUB/ACTIVITY/TEAM, PLEASE LIST IT BELOW.
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