2016-2017 Whitesburg Elementary Media Release Form

2016-2017 Whitesburg Elementary Media Release Form

Dear Parents and Guardians,

Whitesburg Elementary frequently makes submissions of pictures and articles to the local newspaper. We also have several active grade level websites, the school website, and a Facebook page where we would like to post student pictures. Posting a child’s picture is simply a way to share with you the great things happening at WES. Please read the statement below and sign. Circle your choice to give or not give permission for us to post your child’s image.

(Please circle your choice)

I, the undersigned, being legal guardian of ______________________________, GIVE / DO NOT GIVE permission to Whitesburg Elementary School for the right to use my child or children’s photograph, likeness, video or voice recording with or without his/her name, for broadcast or publication in any and all media.

Print Name: __________________________________________________________________

Signature: ____________________________________ Date: ________________Teacher:_______________

**Without your signature on this form, your child’s image will NOT be allowed in any publication other than the yearbook.

2016-2017 Whitesburg Elementary Media Release Form

Dear Parents and Guardians,

Whitesburg Elementary frequently makes submissions of pictures and articles to the local newspaper. We also have several active grade level websites, the school website, and a Facebook page where we would like to post student pictures. Posting a child’s picture is simply a way to share with you the great things happening at WES. Please read the statement below and sign. Circle your choice to give or not give permission for us to post your child’s image.

(Please circle your choice)

I, the undersigned, being legal guardian of ______________________________, GIVE / DO NOT GIVE permission to Whitesburg Elementary School for the right to use my child or children’s photograph, likeness, video or voice recording with or without his/her name, for broadcast or publication in any and all media.

Print Name: __________________________________________________________________

Signature: ____________________________________ Date: ________________ Teacher:_______________

**Without your signature on this form, your child’s image will NOT be allowed in any publication other than the yearbook.