Parent Permission Form For Photo And Student Work Publication Metro-East Web Academy


Parent   P ermission   F orm  
For   P hoto   a nd   S tudent   W ork   P ublication
Metro-­‐East   W eb   A cademy  
Name   o f   S tudent   _ ________________________________________  
As   p art   o f   o ur   o utreach   p rogram   h ere   a t   G resham-­‐Barlow   W eb   A cademy,   w e   a re   a dding   c lass   p ages,   s tudent   w ork,   a nd  
student   p hotos   t o   o ur   w ebsite,   ( located   a t  
),   t o   b rochures,   f lyers   a nd   o ther   d isplays   b oth  
inside   a nd   o utside   o f   t he   s chool.   I n   o rder   t o   p ublish   y our   s tudent’s   a rtwork,   w riting   o r   p hoto,   w e   n eed   t o   h ave   p arent   o r  
legal   g uardian   p ermission.  
These   g uidelines   w ill   b e   f ollowed:  
No   p ersonal   i nformation   a bout   s tudents,   s uch   a s   l ast   n ame,   h ome   a ddress   o r   t elephone   n umber   w ill   b e   p ublished.  
All   s tudent   w ork   a nd/or   p hotos   w ill   a ppear   w ith   a   c opyright   n otice   p rohibiting   t he   c opying   o f   s tudent   w ork   a nd/or  
photos   w ithout   e xpress   w ritten   p ermission.  
If   a nyone   s hould   r equest   s uch   p ermission,   t hose   r equests   w ill   b e   f orwarded   t o   t he   c hild   a nd   t heir   p arent/guardian.  
The   c opyright   o f   t he   w ork   w ill   s till   b elong   t o   t he   s tudent.  
I   u nderstand   t hat   m y   s tudent’s   a rtwork,   w riting   a nd/or   p hoto   w ill   b e   c onsidered   f or   p ublication   o n   t he   W orld   W ide   W eb  
(a   p art   o f   t he   I nternet),   i n   b rochures,   f lyers,   a nd   d isplays   b oth   i n   t he   s chool   a nd   o utside   t he   s chool.  
Yes   No   I   g rant   p ermission   f or   t he   p ublishing   o f   m y   s tudent’s   p hoto,  
artwork,   a nd   w ritings,   b ased   o n   t he   g uidelines   l isted   a bove.  
Please   c heck   e ither   Y es   o r   N o   f or   a ll   o f   t he   f ollowing  
My   S tudent’s   A rtwork  
My   S tudent’s   W riting  
My   s tudent   i n   a   p hoto   –   e ither   i ndividual   o r   g roup  
Parent   N ame   ( printed):     _ _______________________________  
Parent   S ignature:   _ _____________________________________  
Date:   _ _____________  
I,   t he   s tudent,   a lso   g ive   m y   p ermission   f or   s uch   p ublishing.  
Student   S ignature:   _ _____________________________________  
Date:   _ ______________  


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