Learning To Give—STUDENT RELEASE FORM
Dear Parent/Guardian:
Our school is participating in a curriculum project centered on the core democratic principles, especially individual action for the common good. My participation in this project, which is being conducted by the Council of Michigan Foundations Learning To Give (LTG) project, is voluntary. One of the primary purposes of the Project is to enhance student learning and encourage responsible citizenship.
The project might include short videotapes or photographs of lessons taught in your child's class. Although the videotapes and photographs involve both the teacher and various students, the primary focus is on the teacher's instructional lesson and student activities. In this class, your child may appear on the videotape or in photographs. Also, at times during the year, I may be asked to submit samples of student work as evidence of teaching practice and student accomplishment; that work may include some of your child's work.
No last names will appear on any materials that are submitted. No materials or images will be used for financial gain. Some materials or images may be used for educational not-for-profit publication and distribution by Learning To Give. The form below will be used to document your permission for these activities.
Sincerely,
.
(Teacher)
PERMISSION SLIP
Student Name: ________________________________________________________________
Address: ____________________________________________________________________________
School/Teacher: ____________________________________________________________________________
I am the parent/legal guardian of the child named above. I have received and read your letter regarding teacher participation in Learning To Give and agree to the following:
| ____ | I DO give permission to you to include my child's image on videotape or photographs as he or she participates in a class conducted at ________________________________ by ________________________________ (School) (Teacher's Name) to reproduce materials that my child may produce as part of classroom activities. No last names will appear on any materials submitted by the teacher. Any materials or images used by Learning To Give is for educational not-for-profit purposes. |
| ____ | I DO NOT give permission to videotape my child or to reproduce materials that my child may produce as part of classroom activities. |
Signature of Parent or Guardian: ________________________ Date: _________________