Academic Year 2004 - 2005
Dear Parent or Guardian:
The Portland Public Schools
photographs, videotapes and records in other ways some student and classroom
activities for distribution through school newsletters, the Portland
Partnership newsmagazine, other school system publications, and TV3 (the
educational access station managed by the district). On occasion local media outlets such as local newspapers, radio
stations and commercial television stations may also visit the school. In some cases, media that originally appears
in a school system publication, on TV3 or in local media also may be streamed
on the web.
You have the right to deny
permission for your childs name, picture or voice to be used in school system
media. You may do so by completing the
form below and returning it to the secretary at your childs school. You also may use this form to deny
permission for your childs name, picture or voice to be used by local media
outlets that visit the school. If the form is not returned to the school,
then it will be assumed that you grant permission for your child to appear in
the media cited above.
Please note that releases are not
required for events open to the public such as evening concerts, performances
and graduation ceremonies. Therefore,
your child may appear in media coverage of those events even if you fill out
the form below. (Please print).
To:
_______________________________________________(principal)
At:
_______________________________________________ (school)
Regarding:
_______________________________________________ (student's name)
Check appropriate box(es) below:
I object to the use of the above student's name, picture,
or voice in school system media (school newsletters, Portland Partnership
newsmagazine, TV3 programs, etc.) during the 2004-2005 school year.
I object to the use of the
above student's name, picture, or voice in other media (local newspapers,
programming by radio stations and commercial television stations, etc.) during
the 2004-2005 school year.
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Signature |
Date |
Print
name and relationship to the student:___
This form must be signed by a parent or guardian for students less than 18 years old.