To be turned in @ Registration

PHOTO RELEASE & ACKNOWLEDGEMENT FORM

During the school year the Heritage Band Booster Association will be photographing the band and band students at various band functions throughout the year. These photos are for display in a variety of locations including Frisco media publications, the Frisco cable channel, and the Heritage Band web site. It is also possible that the photos and information could be submitted to Dallas Metroplex media outlets as events and accomplishments dictate. The photos published by the band booster club may include student name, grade level, instrument played, and band award(s) received, no other information will be included. Please complete the following (Yes, release the information or No, don't release the information):

Yes      No     Information

1    1     Name

1    1     Photograph

1    1     Grade Level

1    1     Instrument Played

Note to Parents – In order for students to receive recognition for band honors through the media, district publications, the band web site, and the district cable channel, we ask that you think carefully before requesting this information be withheld.  In exercising my right to limit release of this information, I have marked the items of information listed that I direct the Heritage Band to withhold about my child.

Print name of student: ___________________________

Signature of student: ____________________________

Signature of parent: _____________________________

Date: _____________