IMS Student Handbook 2017-2018

Dear Parent/Guardian: We would like to notify you of the Grayson County High School website. This site may be viewed at http://ims.grayson.k12.va.us. Independence Middle School would like to acknowledge student accomplishments by posting pictures to the site. Please complete the information below and return this form to your first period teacher or advisor by August 27, 2015. Grayson County Public Schools Permission and Release Form School Year: 2017-2018 School: Independence Middle School Student Name: __________________________________________ Student Grade Level: _____________________ The purpose of this form is to seek permission for your student to be interviewed, photographed, and/or videotaped by the media (radio or television stations, and newspaper reporters). In addition, Grayson County Public Schools seek permission for your student’s photograph or name to be used on the Grayson County Public School’s website or in its publications. Grayson County Public Schools will not release personal student information to the media. Personal information includes; but is not limited to address, telephone number, medical history, academic records and discipline records. Please check one of the following: ________ YES, I give permission for my student to be interviewed and/or photographed by the media while participating in a school-sponsored event. This includes media and achievement recognition of my student by name, age and grade level. This also includes my student’s photograph or name to be used on the Grayson County Public School’s website, including but not limited to Independence Middle School, or in its publications. ________ NO , I do n t give permission for my student to be interviewed and/or photographed by the media while participating in a school-sponsored event. This includes media and achievement recognition of my student by name, age and grade level. This also includes my student’s photograph or name to be used on the Grayson County Public School’s website, including but not limited to Independence Middle School, or in its publications. Parent/Guardian Signature : __________________________________________ Date: ___________________ Parent/Guardian Name: (Please Print)

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