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_______After completing this form, please check here if the information you have provided has changed from last year so that we can use it to update your child’s student directory information in our computer system. Thank you so much for your cooperation! Dear Parents/Guardians, Periodically, we have requests and opportunities to use students’ names, photographs, artwork and/or comments in various media. Our district puts the highest priority on safety. Therefore, we use the utmost discretion when deciding what is used in West Geauga’s publicity materials. We realize this issue is also a concern to parents/guardians and believe it is important to include you in the decision-making process. To facilitate this, below is a media release form for you to review and sign. If you have any further questions, please contact Sandy Tyler at (440) 729-6803 or e-mail her at Sandy.Tyler@westg.org. __________________________________________________________________________________________ WEST GEAUGA LOCAL SCHOOLS MEDIA RELEASE I, the parent/legal guardian of _____________________________, grade _______, grant West Geauga Local Schools permission to use my child’s name as well as visual images, artwork and/or comments of and from my child in all West Geauga publicity materials. In granting permission, I understand that the images and comments may appear in a variety of forms, including but not limited to magazines, newspapers, books, brochures, newsletters, television, videotape, DVD, advertisements, photographs, yearbook, class photos, fifth grade panoramic photo and the Internet. I acknowledge that neither my child nor I will receive any financial compensation for the publication of said name, visual images and/or comments. I release West Geauga Local Schools from any and all claims arising out of or in connection with the use of the above, including any and all claims for libel. Parent/legal guardian signature: _____________________________________Date: ____________________ Print parent/legal guardian name: _____________________________________________________________ Address: ____________________________________________________Phone: _______________________ E-mail Address: ______________________________________________ Please check one: Permission granted: ________________________ Permission denied: ___________________ PLEASE RETURN THE COMPLETED MEDIA RELEASE FORM TO YOUR CHILD’S SCHOOL. THIS AGREEMENT SHALL REMAIN IN EFFECT FOR THE 2012-2013 SCHOOL YEAR AND SHALL BECOME NULL AND VOID AT THE START OF THE 2013-2014 SCHOOL YEAR.
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