Student Permission to Publish on the Internet

||| Empowering Student Learning |||


I do hereby give Loogootee Community Schools the right to use my:

BOX.GIF (82 bytes) first name
BOX.GIF (82 bytes) photograph
BOX.GIF (82 bytes) published project

for reproduction on the Internet. This material will only be used for activities related to the Loogootee Community 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