Release Form For Media Recording

Release Form for Media Recording In my classroom, students will be working with different levels of technology to facilitate and emphasize their learning in my classroom. Students will occasionally be making presentations using video cameras and microphones. Photographs may also be taken during certain activities. The media recorded in my classroom is for classroom use only. The students will share their media with myself and the others inmy classes. It will not be made available to anyone else.

I, _____________________________________ as legal guardian of (Parent or Guardian’s name)

______________________________________ hereby (Print Minor’s Full Name)

Provide consent -------

Deny Consent

(circle one)

For the use of photographs and other media to be used in Ms. Tischler’s classroom.

Name: Phone: Signature:

Date: