File:  IJNDB-E

Augusta School Department

STUDENT MEDIA RELEASE FORM

2005-2006 School Year

To publicize the achievements of our students, we like to occasionally publish students’ names, photographs, and academic/extracurricular achievements in a variety of media formats such as: school notices, newsletters, our web site, the local newspapers, and television. 

Individual student or class work may be published on the School Department’s web site from time to time in accordance with established guidelines. Such work may include creative writing, research projects, artwork, music, performances, and audiovisual presentations. All student work will include a copyright notice prohibiting the copying of such work without express written permission. If a request for copying is made, the student’s parent/guardian will be notified.

Because your child's safety is our daily concern, we ask that you fill out the information below. We are aware that some parents may have reasons for not wanting a child's name, photo, or achievements published.

Please return this form at your earliest convenience.

Student's name: ______________________________________ Grade: ______________

 Homeroom teacher: _________________________________________________

 ____I DO give permission for my child's name, photo, work and/or achievements to be published in school newspapers, newsletters, local newspapers, and on television.

 ____I DO give permission for my child's name, photo, work and/or achievements to be published on the school web site at http://www.augustaschools.org

 ____I DO NOT give permission for my child's name, photo, work and/or achievements to be published in any format.

Parent/Guardian signature: ________________________    _ Date: _________________

City of Augusta

Board of Education

Approved: