EXHIBITD Release Personal Information

EXHIBIT D

RELEASE FORM FOR THE ELECTRONIC DISPLAY OF STUDENT PERSONAL INFORMATION

I, ___________________________________, (the parent / guardian) of

____________________ (child's name) give my permission for electronic display of

personal information in the form of:

R Photograph, photo-likeness, group photo

R First name, year-in-school

R Information pertaining to school activities or participation in school related activities

R Award, recognition, or honor

R Photograph, photo-likeness, group photo

R Original work, product, research, graphic, or Web site contribution

to be displayed by the District on electronic, video, and/or published media (Web site, CD, TigerVision, newsletters, brochures.)

Student Name: (printed)____________________________

Student signature ____________________________________________

Signature of student’s parent or guardian _______________________________________

Home address _______________________Date ________________

Home phone number (for office use only)__________________________