2014-15 Media Consent Form

Student’s Name: Dear Parent or Guardian: We have so much to be proud of here in School District Five of Lexington and Richland Counties. Our goal is to highlight the successes and achievements of District Five students while honoring their privacy and ensuring their safety. Media Consent: Throughout the year, District Five receives requests from newspapers, on-line news outlets, television stations and radio stations for stories concerning school-related activities. The most common requests are for honor roll lists and information concerning other student accomplishments and successes. There are occasions when student information is highlighted in internal documents including the district’s annual report, various school newsletters, brochures, and other publications. The district and schools also host websites, Facebook pages and Twitter accounts which highlight student and school successes. Today media is integrated more than ever. Any printed material released by the district is likely to be posted on-line and used by other media outlets. Please review the possible opportunities for release of your child’s name and indicate your preference by checking the permission box below. Media Consent includes:

Newspapers and on-line news outlets Television and radio stations District’s annual report, various school newsletters, brochures, other school and district publications District and school websites, Facebook pages, Twitter feeds and other social media

I give permission

I DO NOT give

permission

______ ______ for my child’s full name, photograph, video clip and student work to be included in positive media information provided by district and school officials.

initials

School Year Book Most schools produce a yearbook featuring student names and pictures.

I give permission

I DO NOT give

permission

______ ______ for my child’s full name and picture(s) to be placed in the school yearbook or other annuals.

initials

No student information or pictures will be released without this signed Media Consent Form for your child. This consent form is valid from August 19, 2014 until August 19, 2015. Parent or Guardian’s Name (please print): Parent or Guardian’s Signature: Date: July 2014