Media Release Form (New Students Only) (ONLINE)

We are sending you this parental consent form to both inform you and to request permission to publish your child’s picture and a related article in the following locations: newspaper, school’s newsletter, district’s web page and other public media such as video conferencing.

Video Conferencing provides students and teachers the ability to communicate with content experts and educational providers such as museums, libraries and cultural organizations and with other students in classrooms throughout the world. There may be times when the broadcasts will be converted to streaming video for website viewing and archiving.

This form provides the District with your consent, or preference not to consent, to release this information for publication. This policy will be in effect for grades 7-12 at Park Ridge High School. If you, as the parent or guardian, wish to rescind this agreement, you may do so at any time, in writing, by sending a letter to the principal and such rescission will take effect upon receipt by the school. Park Ridge High School has no control of media use of pictures/statements that are taken without permission.

**If using IE, form must be submitted using IE8 or IE9**

Please hit the ‘compatibility mode’ while using Internet Explorer (See picture below).

Permission*
- I/We GRANT permission for any or all of the above information for publication
- I/We DO NOT GRANT permission for any or all of the above information for publication
Student's Name*
Please use legal name.
First Last
Student's Grade*
Parent/Guardian Name*
First Last
Parent/Guardian Email*
Relation to Student*
Date*
Signature of Parent/Guardian*