PARENT/GUARDIAN AGREEMENT TO PUBLISH STUDENT

PARENT/GUARDIAN AGREEMENT TO PUBLISH STUDENT

INFORMATION ON THE OLD TOWN SCHOOL DEPARTMENT

WEB SITE

Name of Student: Grade or Class:

Parent/Guardian Name(s):

Student Information/Photograph[Work to be Published:

The Old Town School Department's policy is to obtain permission from a student's parent/guardian prior to publishing student information, photographs or work on our web site. A copyright notice is also included prohibiting the copying of student work without express written permission. In the event that a request for copying is made, the student's parent/guardian will be notified.

Please indicate below whether or not you agree to the publication of the information/photograph/work described above and return this form to your child's teacher or the school office as soon as possible.

I grant permission for my child's information/photograph/work to be published on the Old Town School Department web site.

I do not want my child's information/photograph/work to be published on the Old Town School Department web site.

Parent/Guardian Signature Date