Permission Form for Parental Consent
	
Forename	Surname	Reg Group	Address	Tel No(s)	

					
Name of Parent/Guardian:

I declare that I am the legal parent or guardian of the above child.

I give consent for my child to be included in the following activity(ies):  Please tick as appropriate

•	Copyright Permission 

•	Internet Access         

•	Photograph Student 
      
•	Sex Education 
               
•	Data Exchange      
         
•	School Visit    
                
•	Change Clothing Permission 

•	I understand that where I have indicated that my child’s photograph or video image may be used, this will be for school and curriculum purposes only and may be used for displays, promoting a positive image of the school, newsletters, press releases etc., and that my child’s name will not be included in published images.  

Signed:	Date:	

Please return to Ms Dixon in the School Office