Montville Township High School
100 HORSENECK ROAD ● MONTVILLE, NJ 07045 ● (973) 331-7100
Douglas Sanford, Principal
Kenneth Nadzak, Assistant Principal
David Gelber, Assistant Principal
Leslee Scheckman, Director of School Counseling
Wayne Guarino, Supervisor of Athletics
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Parental/Guardian Consent Form
Photos and Videos for public release including the Internet and/or Cable Television
I am sending you this letter to inform you and to request your permission for your child’s photo/image and/or videotaping of personally identifiable information to be published on the Montville Township School District Internet site and/or a final DVS that might be viewed by the public.
As you are aware, there are potential dangers associated with capturing personally identifiable information since global access to the Internet or viewing of a videotape or cable program does not allow us to control who may access such information. These dangers have always existed; however, we as a school system do want to celeb rate your child and his/her work. The law requires that we ask for permission to use information about your child.
Pursuant to the law, we will not release any personally identifiable information without prior written consent from you as parent or guardian. Personally identifiable information may include one or more of the following: student name, photo or image, school address, e-mail address, and locations and time of Montville trips and classes and events.
If you, as the parent/guardian wish to rescind this agreement, you may do so at any time in writing by sending a letter to the classroom teacher and such rescission will take effect upon receipt of the letter.
Check ONE of the following choices:
I/We GRANT permission for the student’s photo/image/videotaping, name and school listed below to be published on the Montville Township School District Internet site, the cable access channel and/or media, e.g. press release.
I/We DO NOT GRANTpermission for the student’s photo/image/videotaping, name and school listed below to be published on the Montville Township School District Internet site, the cable access channel and/or media, e.g. press release.
Photo (s)/image (s) posted on the Internet will appear on the Montville Township website at or on the local cable access channel 22.
Student’s Name (please print): ______Little Mustangs Preschool Program
Name of Parent/Guardian (please print): ______
Signature of parent/guardian: ______Relationship to Student: ______
Date: ______Return this form to:
Gayle E. Brown, MTHS FCS Teacher
100 Horseneck Road
Montville, NJ 07045
973-331-7100 x 2703