Please print, sign, and return.

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Internet/Photo/Video/Audio/Writing Release Form
for the classroom web sites

This release form is being requested to obtain permission to put your child’s work on the classroom web pages. These sites can be accessed through the Internet of:

Mr. John McCarthy - http://epiphany.simplenet.com/mccarthy/
and
Mr. Scott Banks – http://www.clarkston.k12.mi.us/bankss/

No individual pictures of students, nor will their last names, or addresses be used on the classroom site, in addition to the guidelines of Clarkston High School. The purpose of this release form refers to materials on the Internet and activities related to our World Wide Web site such as educational publications and conferences, newspapers, radio broadcasting and/or television programming.

As the parent of _________________________________________________________,
Student’s name

I authorize Mr. McCarthy and Mr. Banks to use group photographs, audio recordings, video recordings, writing samples, and press releases, in which my child is involved for publication purposes on the school related web site. Furthermore, I grant permission for my child’s grades and average to be posted as an anonymous listing, so that I may monitor his/her progress. I will receive a password in order to view his/her grades. Finally, my child may receive an email account that is specifically for class related activities. If my child wishes to use this email account for other than class related activities (ie: personal letters and contacts), he/she must get my permission.

This release will remain in effect until I revoke it in writing to Clarkston High School and Mr. McCarthy.

_______________________________________________________________
Parent’s/Guardian’s name (please print)

Contact Number:

(_____) __________________

Email:

____________________

Parent’s signature: __________________________________ Date: _______________

Please tear on the dotted line below and return the top part to Mr. McCarthy.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

This site can be accessed through the Internet at:

Mr. John McCarthy - http://epiphany.simplenet.com/mccarthy/
and
Mr. Scott Banks – http://www.clarkston.k12.mi.us/bankss/

For both, work contact at: 248-623-3600

Mr. McCarthy - jmc2ocla@moa.net
Contact at school for home phone number, which can be used up until 10 pm.
Mr. Banks - scottbanks@usa.net