Student Permission Form

STUDENT PERMISSION FORM

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VIDEOCONFERENCING PARTICIPANT WAIVER

I understand that in a Distance Learning Classroom (videoconferencing lab) my physical presence and participation in classroom activities will be transmitted to distance learning sites and will be electronically recorded.  I understand that my signature indicates my presence, participation, and electronic recording of these classes will not be a violation of my personal rights and hereby release any claims for the use of such.

_____    I give my permission to participate in videoconferencing.

_____    I would prefer NOT to participate in videoconferencing.

Student Signature:

______________________________________________________________

Date:  _____________________________

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WEB SITE/INTERNET/Streaming VIDEO NOTIFICATION/PERMISSION

To effectively illustrate the educational activities of students, a video will be posted to a web site and/or distributed via email/internet. The name of students will not be posted, only their video.  In order to use this video, we are requesting your permission.  Please complete the following:

_____    I give my permission to distribute my video via the Internet or placed on a web site.

_____    I DO NOT want my video to be distributed via the Internet or placed on a web site.

Student Signature:

______________________________________________________________

Date:  _____________________________

Parent Signature____________________________________________

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