Adult Permission Form Concerning Video Taping, Photographing, and Audio Taping of Self, and Distribution of Personal Information and Images

Dear Faculty, Staff or Community Member,

Today's many different communications media -- including video, audio, and Internet -- could allow the publication of your name and/or photo in a manner accessible throughout the district and across the world. SBISD, in attempting to accommodate diverse wishes, has determined that each adult will decide the extent to which information about himself or herself may be published by SBISD in a manner accessible by others outside the school community.

By indicating "yes," you are giving the Spring Branch Independent School District permission to perform the act indicated without further permission from you. In this permission form, "disclose" means to permit access to or the release, transfer or other communication to any person (other than school officials SBISD has determined have a legitimate educational interest) by any manner or means, including oral, written, or electronic release to the news media and on the Internet's World Wide Web.

YES, I give permission to SBISD to:	NO, I do not give permission to SBISD to:
_____	_____		Make or authorize others to make videotape recordings or photographs of myself.
_____	_____		Disclose my individual photograph or a videotape of my individual image.
_____	_____		Disclose my individual photograph or a videotape of my individual image along with my name.
_____	_____		Disclose my photograph when included in a group or a videotape in a group.
_____	_____		Make or authorize others to make recordings of my voice

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           Printed Name of Adult Affiliation

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            Adult's Signature Date