Miami-Dade County Public Schools Media Release Parental Consent Form Page 3

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LEKÒL LETA MIAMI-DADE COUNTY
FÒM KONSANTMAN PARAN POU PIBLIKASYON NAN MEDYA
_______________________
(Dat)
Chè Paran:
Silvouplè n ap avize w, pandan ane a nou kapab pran foto pitit ou a, anrejistre li nan
videyo, oubyen fè entèvyou avèk li nan divès evènman lekòl la ap patwone. Si ou bay
konsantman ou, nou ka repwodui oubyen pibliye foto, videyo oubyen entèvyou yo nan
medya tankou, jounal, bwochi, videyo, televizyon, Entènèt, ak sit Entènèt Lekòl Leta
Miami-Dade County ak platfòm medya sosyal tankou Facebook, Twitter, eks.
Silvouplè chwazi preferans ou anba a.
  
___________________________
_________________________
(Non Elèv la)
(Nimewo Idantifikasyon Elèv la)
Wi.
Nou ka repwodui e pibliye foto/videyo/entèvyou pitit mwen an pou
itilize yo nan medya
.
Non.
Nou pa dwe repwodui e pibliye foto/videyo/entèvyou pitit mwen an pou
itilize yo nan medya.
___________________________
________________________
(Siyati)
(Dat)
Siyen fòm sa a e retounen li bay:
MOUN POU W KONTAKTE: ____________________________________________
NON LEKÒL LA: _____________________________________________________
TELEFÒN LEKÒL LA: _________________________________________________
FM-7489H Rev. (05-16)

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