TVUSD+Media+Release 2011- 2012 by babbian

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									                                                    Temecula Valley Unified School District
                                                               31350 Rancho Vista Road
                                                                     Temecula, CA 92592
                                                                          (951) 676-2661



                             MEDIA RELEASE FORM




Student’s Name: _________________________            Grade:______________

School: _______________________________________________________



Throughout the 2011 – 2012 school year, your child’s class could be filmed for the
purpose of providing teachers footage of their lessons for evaluation purposes. The
footage may also be shared with other teachers inside and outside the Temecula
Valley Unified School District to showcase effective teaching techniques. Please
indicate below whether you consent to your child’s likeness being recorded.




_____ I consent to my child’s likeness being recorded

_____ I DO NOT consent to my child’s likeness being recorded




Parent/Guardian’s Signature: ___________________________________

Parent/Guardian’s Name:______________________________________

Date:____________________

								
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