I,
LSUHSC-HDC EARLY LEARNING CENTER
PERMISSION TO PHOTOGRAPH
I, __________________________, give permission for the Human Development Center Early
Learning Center to videotape, audio record, and photograph my child, ________________________, for the following purposes:
|Type and Purpose: |(Please check one) |
| |Grant Permission |Decline Permission |
|STILL PHOTOGRAPHS |
|Display in classroom scrapbook, activities | | |
|Display in facility’s bulletin boards, shown to current and prospective | | |
|clients | | |
|Display still photos on LSUHSC child care website | | |
|Teaching or research | | |
| |
|VIDEOS |
|LSUHSC promotional video, electronic bulletin board, teaching, research | | |
| |
|ASSESSMENT DOCUMENTATION (used for educational and assessment purposes only) |
|TS GOLD Teacher Assessment - photos, audio and video clips used for | | |
|documentation of development predictors of school success which are | | |
|aligned with the Louisiana Birth to Five early learning guidelines | | |
Only photos and or classroom names will be displayed on the facility website or bulletin boards NO children’s names will ever be displayed.
I understand that it is my responsibility to update this form in the event that I no longer wish to authorize one or more of the above uses. I agree that this form will remain in effect during the term of my child’s enrollment.
Signed:
_____________________________________________ ________________
(Parent or Guardian signature) (Date)
................
................
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