Attention Cast and Crew of

Student Privacy Permission Form for FHTMS Drama Related Activities

February 2008

During the course of participating and/or performing in an FHTMS Drama Club production, it is critical to have parent permission to include private information about each student.  This private information (name, photo, video) is required to acknowledge a student’s participation in the show and would be used only for show related purposes such as, but not limited to, the following:

• show program
• articles, photographs and video footage in the local media such as The Other Paper, the Burlington Free Press and other local papers and/or broadcast media
• show photographs taken to document the experience (generally culminating in a CD offered to all student family, without names)
• a single archival videotape of the show (housed in the SB Community Library)
• student photo gallery to be displayed in the lobby of SBHS during the days of the performances

The private information that will be given for these purposes shall include the following:

                        Student full name

                        Student photograph

                        Video of student

I give my permission for the above private information to be used in conjunction with this year’s FHTMS Drama Club production.  This permission will override any limitations on the use of private information that I have noted on the SBSD Student Privacy form only for purposes related to this year’s FHTMS Drama Club production.

Student Name: __________________________________________  (please print)

Parent/Guardian Signature: _________________________________ (date)