Media And Internet Release Form
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1Student Name:_________________________________
ID Number:______________
(Please Print)
School: __________________________________
Grade Level:_____________
Media and Internet Release Form
The Vermilion Parish School Board and any of its schools may develop, participate in, or be the subject of
media-based presentations and events which highlight various educational activities that take place during
the course of the school year.
1. Those developed by Vermilion Parish School Board personnel. These may include but are not
limited to
o Name and/or Photograph of your child and/or their work
o Slide/tape presentations of your child and/or their work
o Videotapes of your child and/or their work
o Computer generated presentations which may incorporate photographs and video clips of your
child and/or their work
2. These media based presentations may be used in
o Faculty in-services
o Classroom Activities/Projects
o Parent programs
o Staff development activities
o Media festivals (local, state and international)
o Public relations / Radio/ Newspaper Articles
o TV presentations
o Vermilion Parish School Board Internet web pages
Check ONE:
YES
, I hereby GIVE my permission to Vermilion Parish School Board and its schools
to publish my child’s photograph and identification, as well as to publish my child’s work or
presentations (examples above) in any of Vermilion Parish School Board’s media-based
productions for any of the above stated purposes from now until my child leaves the school
system or at which time I so request in writing.
NO
, I hereby REFUSE to give the Vermilion Parish School Board and its schools
permission to publish my child’s photograph, identification, and/or work in any of VPSB’s
media-based productions for the above stated purposes.
_________________________________________________
_____________________
Parent/Guardian Signature
Date
(Note: Professional media presentations may require additional release)
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