Tipton Academy

Student  Photo/Video  Permission  Form          

As the Parent(s)/Guardian(s) of                             (Students  Legal  Name)  I/We  hereby  grant  permission to Tipton Academy to use  photos,  printed names, video footage of our children in  school publications, postings in the building, at presentations, and on the school website.  

I/We also grant permission for our child to be identified in an accompanying caption used with snapshots as a news item for the school.        

Parent/Guardian:              
Printed  Name:              
Date:              
Address:              
Telephone  Number:              
Grade  and  Home  Room  Teacher:                    

Note:  This form is  not required for large group photos where individuals are not identified, or to have a student's name and photo printed in the school yearbook. If you do not want to have your child(ren) to appear in the school yearbook