As Internet usage becomes more common in school learning environments, issues of personal privacy and security need to be addressed. It is important to be aware that images and school work have the potential to be viewed by many internet users. Whether or not you wish to have your work and/or image(s) posted on the internet is a matter of personal choice. Please read this form carefully, consider the options for release of information on the Internet, and check the appropriate options based on your preference(s).

I, _________________________________________, give Eisenhower High School, within the Yakima School District, my permission to post the following type(s) of information about me on the Internet. Eisenhower High School, its faculty and staff, the Yakima School District, and ESD 105 are not held liable for the release of information permitted by this agreement. This release form stays in effect until revoked by me in writing, or through e-mail notification, or verbal authorization. If I should leave or transfer from Eisenhower High School for any reason, this release form is no longer valid. I also agree to give the website manager a reasonable amount of time (not to exceed 30 days) to have my work and/or images removed from the school webpages in which these items appear.

I am a student / staff member / faculty member / administrator / parent or guardian. (Please circle the appropriate designation.)

Please check the preferred option(s) for release of work and/or images to be posted on the Internet:

_____ 1. Coursework only

_____ 2. Images only (no name will accompany any image containing your likeness)

_____ 3. Name only

_____ 4. No limitations on coursework, images, and names (any posting must be approved by you or a parent/guardian (if applicable)).

_____ 5. Personal preference(s) _________________________________________________________

 

Your signature _____________________________________________ date _____________________

 

Parental/guardian signature ______________________________________ date ___________________ (if under 18 years of age)

(updated 9-3-99)