Student Permission to Publish on the Internet

Student Permission to Publish on the Internet

Consent

I do hereby give Indiana Department of Education & Rhoades Elementary in MSD Wayne Township, Indianapolis the right to use my:

    first name
    photograph, still or video
    published project

for reproduction on the Internet. This material will only be used for activities related to the Indiana Department of Educationís web site & Rhoades Elementary School's web site.

Student's Address: ______________________________________
Date: _____________________	_______________________________ student's signature
	_______________________________ student's printed name

Guardian's Consent if student is under 18 years of age

I am the parent or the legal guardian of the above-named minor and hereby approve the foregoing and consent to the use of photograph, name, and published project to the pursuant terms mentioned above.

I affirm that I have the legal right to issue such consent.

Parent's Address: ________________________________________
Date: __________________	_______________________________ parent's signature
	_______________________________ parent's printed name

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Denise Brinker
This page last updated: 01 May 2003