Media And Vr Consent Form

ADVERTISEMENT

CLEVELAND METROPOLITAN SCHOOL DISTRICT
Media/IVR Consent Form
(Check the Applicable Box)
RETURN THIS FORM TO YOUR CHILD’S SCHOOL
I hereby irrevocably consent to the unrestricted photographing,
videotaping or otherwise recording or broadcasting or publishing and
other unrestricted use of my child’s writing, photographs, video, image or
likeness, or quotes without limit, reservation or remuneration by the
media and/or the Cleveland Metropolitan School District (CMSD). CMSD
shall be the sole and exclusive owner of all rights to the said recordings it
has taken. I release all rights in the said recordings on behalf of myself
and my ward/child.
I do not consent to the photographing, videotaping or otherwise recording
or broadcasting or publishing and other use of my child’s writing,
photographs, video, image or likeness, or quotes by the media and/or the
Cleveland Metropolitan School District.
I do not consent to receiving IVR (Interactive Voice Response) messages
to my home or emergency phone numbers at any time including
notifications of school-related emergencies.
STUDENT INFORMATION
Student Name ___________________________________________________
School _________________________________________ Grade ___________
Parent/Guardian Signature __________________________________________
Parent Printed Name: ______________________________________________
Home Address: ___________________________________________________
Home Phone: _____________________________________________________
Cell Phone: ________________________________
Date ______________________________________
* Disclaimer: As a matter of policy, the Cleveland Metropolitan School District will not publish both a
student’s name and photograph together.
* Students over the age of 18 do not need to obtain parental consent.
The goal of the Cleveland Metropolitan School District is to become
a premier school district in the United States of America.
The Cleveland Board of Education does not discriminate in educational programs, activities
or employment on the basis of race, color, national origin, sex, sexual orientation, age, religion or disability
.
6/09

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Education
Go