Bentworth School District

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Welcome to the Bentworth School District!!                  Title 1 Distinguished Elementary School               Ranked as a U.S. News Best Middle School              Identified as a Schools To Watch Middle School  (3x)            National Blue Ribbon High School                       Ranked as a U.S. News Best High School                Bentworth High School Global Educational Excellence Award            

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MEDIA PERMISSION FORM

Bentworth School District

Media Permission

School:*
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MEDIA PERMISSION FORM

BENTWORTH SCHOOL DISTRICT

During the school year your child may have the opportunity to experience various forms of learning through media. In order for your child to participate, Bentworth School District requires your permission. Your signature is requested below on three separate items. Omission of a signature on any portion of this form will mean your child does NOT have your permission for that particular item.

 VIDEO CONFERENCING PARTICIPANT WAIVER

I understand that in a Distant Learning Classroom my child’s voice, physical presence and participation in classroom activities will be transmitted to learning sites and will be electronically recorded. I understand that my signature indicates participation and electronic recording of these classes will not be a violation of my child’s or my personal rights and hereby release any claims for the use of such.

This document is binding. In the event that you would like to cancel this contract you must submit your request in writing to the school.

I give permission for my child to participate in videoconferencing.*
Answer Required

WEBSITE/INTERNET PICTURE NOTIFICATION

To effectively illustrate the educational activities of students in our schools, Bentworth School District may desire to post your child’s picture to the school website and school social media sites such as Instagram, Twitter, and Facebook. The name of the student will NOT be posted, only the picture. In order to use the picture, we are requesting your permission.

This document is binding. In the event that you would like to cancel this contract you must submit your request in writing to the school.

I give permission for my child’s picture to be distributed via email/internet including the Bentworth website and social media sites.*
Answer Required

TELEVISION/NEWSPAPER PARTICIPANT WAIVER

I give my permission for my child to be interviewed, recorded and/or photographed for television (including video viewing sites such as youtube and vimeo) and/or newspaper. I understand that my signature indicates that this will not be a violation of my child’s or my rights and hereby release any claims for the use of such.

This document is binding. In the event that you would like to cancel this contract you must submit your request in writing to the school.     

I give my permission for my child to be interviewed, recorded and/or photographed for the television and/or newspaper.*
Answer Required