Manhattan Beach Unified School District
Manhattan Beach Middle School

Instructions:  Fill in form, print, sign and send to MBMS office.

PARENT/GUARDIAN RELEASE FORM
FOR PHOTOGRAPHS OF STUDENTS

Student: Grade:

Program:

You have my permission for films, video and/or audio tape recordings, slides and photographs to be taken of during classroom instruction, assessment and other school-related activities.  I understand that this media will be produced and used for educational purposes.

The media may be used:
on a school-related website
included in a school related publication

You do not have my permission for films, video and/or audio tape recordings, slides and photographs to be taken of for any reason.

This release will supercede any previous releases on file.


___________________________________________
Parent/Guardian signature


Address


Phone


Date

Please return this completed and signed form to the office.