Mesa Homeschool Enrichment

STUDENT PHOTOGRAPHY RELEASE AND INTERNET USE FORM

This form gives Leman Academy of Excellence authorization to use student information and photographs taken of your child for educational purposes, including yearbook, newsletters, newspaper, flyers, brochures, website, announcements and other publicity.

Please check ONE of the following for photography release:

I approve of Student Information and Photograph Release without reservation, compensation or restrictions.I approve of Student Information and Photograph Release for school/class pictures and Yearbook. I understand these pictures will only be used for individual pictures, class pictures, and Yearbook.I DO NOT approve of any Student Information or Photograph Release for my child. I understand this means my child may not be photographed or interviewed under any circumstances including outside agencies. (Please Note: This option includes, but is not limited to, school pictures (individual), class pictures and/or yearbook pictures).

Please check ONE of the following for Internet release:

I DO hereby give permission to allow access to the Internet for my student. I may withdraw my permission at any time and the student's access will be denied immediately. Any Leman Academy staff member may also cancel the student's access at any time for any reason.I DO NOT give permission to allow access to the Internet for my student.

I understand that I may revoke or change these permissions at any time. In order to do so, I will need to complete and re-submit this document to the Office.

*Parent Name

*Parent Signature

*Date

*Email

*Phone Number
*Child's Name

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