________________________ School continues to integrate technology throughout the curriculum. At times we would like to display student pictures and student projects on school and/or classroom web pages. This means that your child’s picture or project could be seen by anyone with internet access.

Please sign and return this sheet giving or restricting permission for your child’s photo and/or work to be displayed on the World Wide Web.

My child’s photo (Check only one.)

___ may be displayed with his first name and last initial on an instructional website.

___ may be displayed with NO identification on an instructional website.

___ may NOT be displayed on an instructional website.

My child’s work (Check only one.)

___ may be displayed with his first name and last initial on an instructional website.

___ may be displayed with NO identification on an instructional website.

___ may NOT be displayed on an instructional website.

Student’s Name: _________________________________

Teacher:________________________________________

Parent Signature: ________________________________

Date: ______________

8/02