Robert Smith School

300 Sophia Street

Selkirk, Manitoba R1A 2E2

Permission to Photograph/Videotape
During the school year, opportunities may occur to photograph or videotape your child in
connection with the educational programs in our school. These photographs and/or videos may
be used in the school newsletter, the school website, yearbooks, bulletin boards, local or regional
newspapers, television, or as part of promotional events.
We are asking parents/guardians to indicate whether they give, or do not give, permission to
have their child included in photographs/videos taken at the school. We will ask permission at
the beginning of each school year, however, if circumstances change and you want to revoke
your permission, you may do so by informing the school at any time. Please complete and return
this form as soon as possible.

Please answer Yes or No to the following statement:

I hereby give permission for my child to be photographed/videotaped and to have the
pictures/videos used for the purposes outlined above during the school year.
Yes

No

Childs Name:
Parents/Guardians Name:
Parents/Guardians Signature:

Date:
*Please note: Use of any student information will also follow the Lord Selkirk School Division guidelines for
posting school, student, and/or staff information on the Internet.
http://www.lssd.ca/division/acceptable_use_policy/