School Release Form printable pdf download

COMMUNITY CHRISTIAN SCHOOL

RELEASE FORM NOTIFICATION REGISTRY

PHOTO RELEASE

Technology plays an important role at Community Christian School. Students are exposed to a number of programs that will help them

improve academics. During the school year, CCS students are often involved in activities that involve taking pictures for public media

(such as: Internet web design, newspapers, marketing publications, etc.). We are constantly updating our website and we would like to

celebrate student achievement by posting pictures on our web site, in newsletters and in our yearbook.

Students names are not listed in our promotional materials but likenesses are used to help promote the programs of the school. We

like to feature our students working together in the classroom and participating in school activities. Your consent is required for your

child to be included in any of the pictures. Your child will not be identified by name except in the yearbook. We make every effort,

especially on web pages, to NOT give personal information or identity. The sole purpose of photos is to help promote school programs,

while protecting the privacy of individuals.

In addition, the local paper, The Palladium-Item, features articles and/or photos that feature our students. At times, The Palladium-Item

will print names of students, either with photos or in articles, such as Honor Roll, Science Fair, or general information that highlights the

programs of the school.

Please mark applicable line below:

_____ I hereby give consent for my child to be included in any pictures taken. I know that they will not be used for any commercial

purposes and will be used solely for displaying the dimensions of the program. I also give consent for my child’s name and/or likeness

to be printed in the local paper, if the occasion arises. I also consent for my child to be included in pictures taken for promotional

materials and on the school website.

_____I hereby request that my child NOT be photographed, videotaped, or interviewed for possible use in newspapers, television, radio

broadcasts, or the school websites.

SCHOOL DIRECTORY

Your family has the option of having your names, addresses, home telephone number, and/or email address in the school directory.

_____Yes, please include the following information in the CCS directory.

Parent/Guardian Names___________________________________________________________________________

Address:_____________________________________________________HomePhone________________________

City

State

Zip

Primary email address____________________________________________________________________________

Student Names, Grades, & Date of Birth______________________________________________________________

______________________________________________________________________________________________

The following will only be given to Room Parents:

Cell Phone Number 1______________________________________ 2_____________________________________

Alternative email addresses_______________________________________________________________________

_____No, we do NOT want our information published.

______________________________________________________________________________________________

Parent Signature

Date

(over)

AS A SERVICE TO OUR VOLUNTEERS: According to the CCS policy regarding volunteers, (see CCS Handbook, 5:14)” All CCS

volunteers must have a clear Criminal background check, on file in the CCS office.” The following paperwork for Limited Adult Criminal

History Information is provided for your convenience in fulfilling this requirement.

CCS will submit this paperwork (4) four times per year, to the Indiana State Police, at not charge to you. You may copy this page for

additional persons, such as other friends or family members who may wish to drive on, or attend field trips, or serve in any other

volunteer capacity. If you do not submit your paperwork in a timely manner, a Limited Adult Criminal History may be obtained through

Barada, Inc. at your cost.

Pesticide Notification Registry for Schools

At least 48 hours prior to a pesticide application at a school, the school corporation must provide planned pesticide application details to

parents, guardians, and staff members requesting to be notified. Parents, guardians and staff must be registered with the school

corporation to receive such advance notice. To register, individuals need to contact the school office and provide an e-mail address for

notification purposes.

School Release Form

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