IJNDC-E Website Release Form
NEPN/NSBA Code: IJNDC-E 

WEBSITE RELEASE FORM 

From time to time we take pictures and shoot videos to use in our newsletters and for other school publications and projects. One of the district publications is our website located at http://www.sad4.com. As part of this website, we want to be able to showcase student work and activities and recognize their achievements.

M.S.A.D. #4 has developed the following content guidelines for the district website in this regard.

A. No personal information, including full name, address, phone number, birth date, social security number, or email address of a student, will be provided on a school website.

B. Photographs of large groups of students may be posted on a school website without parental permission as long as individual students are not singled out or identified in any way (e.g., a school assembly, sporting activity, or music festival).

C. Parental permission must be obtained before photographs of individual children or small groups of children (e.g., class photos) are posted on a school website.

D. Students will be identified by first name only unless we have specific parent permission to use the student’s entire name such as when an award is presented or student work is displayed. (Photos and rosters of school groups or teams may include full names and or uniform numbers since this information is regularly published in local newspapers as well.)

Please complete and return the form on the following page to your child’s teacher promptly.

SAD # 4 Web, Print, & Presentation Media Permission Form 
Please check Yes or No for each statement: 
Print:

I grant permission for photos of my child’s participation in school activities to appear in local newspapers such as: The Bangor Daily News, Piscataquis Observer, and the The Moosehead Messenger.                  Yes___ No___ 

World Wide Web: 

I grant permission for photos and/or video clips of my child’s participation in school
activities to appear on SAD #4’s web pages. (No student names will be published with images on school department web pages.) Yes___ No___

Student Work:   

I grant permission for my child’s work to be posted on SAD #4 web pages, using my child’s first initial and last name only. Your child retains all copyright to his or her original work. I understand that, in the event that anyone requests permission to copy or use my child’s work, those requests will be forwarded to us as parents.
                                                                                                                                                    Yes___ No___

School Publications: 

I grant permission for photos and/or video clips of my child’s participation in school activities to appear in various publications made available to other members of the student body. Examples of these publications include: school yearbooks, class or school newsletters, videos or pictures from field trips, class slide shows, senior video, and DARE presentations.                                                                                                                     Yes___ No___

Videos of School Activities: 
I grant permission for my child to appear in videos taken during public performances
and assemblies and made available either on the web or on DVD. These are generally events like the Veterans Day Assembly, concerts, games, plays and graduation but may include other similar events.                                             Yes___ No ___

Educational Presentations: 

I grant permission for SAD #4’s educators to present examples (print, digital, or video) of my child’s work and/or participation in school activities at educational conferences, workshops, and classes, and at venues that promote the school or school department. Students’ addresses, phone numbers, and email addresses will NOT be published.                                                                                                                                        Yes___ No___

I understand that the viewing and use of this material once published or posted cannot be controlled by SAD #4, nor can the district control images recorded at events that are open to the public. 

_________________________________
Name of Student

_________________________________    __________________________________ ___________
Signature of Parent/Guardian                         Printed Name of Parent/Guardian             Date

Parents may change their permission at any time by notifying the school in writing.
Please return to your child’s school as soon as possible. 

Adopted:       March 12, 2002
Revised:       December 9, 2003, November 9, 2010


M.S.A.D. #4