Photo/Video Release Form Students/Staff

As part of our PPCD Training Initiative, during the 2011-2012 school year,
RRISD employees will be documenting teaching strategies, student progress
and the instructional process through the use of video and still images.
I hereby give permission for images of my child (or myself, if RRISD
employee), during the school year through multi-media purposes (video,
photos, digital camera, etc.) to be used for the purposes of self-assessment,
staff development, ongoing instruction, workshops and other areas deemed
appropriate by RRISD Special Education Department, and waive any rights
of compensation or ownership thereto.

If you are granting permission please fill out this section:

I grant permission for my child to be photographed/videotaped for the purposes
described above.
Name of person who may be photographed/videotaped: ___________________________
Signature: ____________________________ Relationship: _______________________
Date: ___________________________________________________________________
_______________________________________________________________________
_
If you are NOT granting permission, please fill out this section:
I decline permission for my child to be photographed/videotaped.
Childs Name: ________________________Relationship: ________________________
Teacher: ____________________________ Campus:____________________________
Signature: _______________________________________________________________
Date: ___________________________________________________________________
Please direct any questions regarding this release to your childs classroom teacher or
Donna Worley at 512.464.5972 or by email at donna_worley@roundrockisd.org