Regulation 5095: Web Publishing Permission Form

Permission To Publish Student Work On The Web

(Printable form to submit)

In accordance with Board of Education Policy No. 5095, Web Publishing, the Chappaqua Central School District maintains a District website and school websites in order to share information with students, parents, staff and community members. The policy states that the District may publish unidentified photos of students and unidentified examples of student work on these websites, unless parents opt out (see the last option below). The policy further states that photos of students and examples of student work may be identified by name when placed in a password protected place on the website and when permission has been obtained.

In addition, and to simplify the process for ALL web information, the District may also utilize student identified (first and last name) photos in the web publication of “News and Views” or student identified (first and last name) and photo in a video clip for the district website with parent and/or guardian permission. Please consider giving permission for student’s identified photos, video, or work to be used for the coming year.

Please choose your option and complete the information below. Sign and return by September 14 to:

Liisa Elsner, District Clerk
Chappaqua Central School District
66 Roaring Brook Road
Chappaqua, NY 10514

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_______ I give permission for examples of my child’s work (such as artwork, written work or verbal statements) and those photos, which identify my child, to be placed in a password protected site restricted to my child’s classmates and families. Identification in such sites shall be limited to first name, last initial.

_______ I give permission for my child’s identification (first and last name) to be used with his or her photo as used in district publication, such as “News and Views” to be posted on the district website.

_______ I give permission for my child’s identification (first and last name) to be used with his or her work for a video clip to be posted on the district website. 

I hereby agree to release, hold harmless, indemnify and defend the Chappaqua Central School District, and its Board, officers, employees, their successors, assigns and representatives in their official and individual capacities from any and all liability and legal or equitable claims of any kind related to such photos or works being published on the district’s or school’s website.

______ I do not give permission for any photos, videotapes, class work, or examples of my child’s work to be placed on the district’s or school’s website or in password protected sites.

Please be advised if this form is not returned by Friday, September 14, the District will assume that you do not grant. . .

Student(s) Name and School: (please print)
________________________________________________
________________________________________________
________________________________________________

. . .permission for identified photos of your child or examples of your child’s work to be published.

Parent/Guardian Signature:  ___________________________________________
Print Name: ___________________________________________________________
Date: ____________________________    

Administrative Regulation 5095 (Printable form to submit)
Adopted by Superintendent: March 25, 2009, Revised: August 27, 2013