Canton City School District Student, Family and Community Support

MEDIA/APPEARANCE RELEASE AND DIRECTORY INFORMATION

Student Name HR Teacher

School RM# _________ Grade

I. MEDIA/APPEARANCE RELEASE: As parent/guardian, I  do /  do not (please select one) give permission to the Canton City School District to use my child’s photographs or likeness (filming, interviewing, etc.) in all publications, audio/visual presentations, television or radio broadcasting, and/or internal/external media news stories. This includes photographs, slides, audio/visual and computer email or web pages. Furthermore, I assign all rights to the Canton City School District and authorize the reproduction, broadcast, cablecast, sale, copyright, exhibition, and/or distribution of said recordings and or prints without limitation. Parent/Guardian Signature: ____________________________________ Date: _____________________

II. DIRECTORY INFORMATION:

File:JO-E

State law does not restrict the release of “Directory Information” of students except to prohibit its release for profit-making activities. Directory information includes:  name  address and telephone number  date and place of birth  extracurricular participation  achievement awards or honors  weight and height (if a member of an athletic team)  dates of attendance  date of graduation  major field of study Ohio Revised Code also requires the release of directory information of high school students in grades 10 through 12 to military recruiters, unless the student (over 18) or his/her parent specifically requests such information not be released. If you do not want “Directory Information” about your child released, you must fill in the form below and return it to your child’s building records secretary. All forms must be received by October 1 of the current school year. Denial forms will be valid for a period of one year. I, hereby, request that the Canton City School District NOT release “Directory Information” about my child.

Parent/Guardian Signature: ____________________________________ Date: _____________________

Rev.8/10/15