​PARENTAL CONSENT FORM
​Student Photos, Videos, and Biographical Information​


​Dear Parent/Guardian:
​
It is our practice to seek parental consent before including your child’s photograph, recorded video, and/or biographical information on web pages or in any publication, or to release any images to the media, for the purpose of showcasing the accomplishments of our Service Above Self (SAS) Award recipients. In order to release or include your child’s image and/or biographical information in our SAS Award Program, we must have your consent. Please review the three sections below and complete every item identified with an “*.” Once you have completed your responses, please press “SUBMIT” at the bottom of the form.

    ​Section I: Internal Use of Photographs, Video, and/or Biographical Information
    ​I grant permission to take and/or use photographs/video images and/or biographical information of my child for internal use such as the Trumansburg Rotary Club website (TburgRotary.org), Facebook page, and club presentations.

    ​Section II: External Use of Photographs, Video and/or Biographical Information
    ​I grant permission to take and/or use student’s photos, videos, and/or biographical information for external publications such as press releases, print ads, or other publications related to my child’s participation in Trumansburg Rotary Club’s Service Above Self Award.

    ​Section III: Charles O. Dickerson High School Use of Photographs, Video and/or Biographical Information
    Student’s photos, videos, and/or biographical information may be used for Charles O. Dickerson High School’s website, student recognition bulletin boards, school newspapers and newsletters, electronic signage board, etc.