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)__________________________