Form JG(1)-2 Empowering Dreams for the Future PERMISSION TO ALLOW STUDENT TO PARTICIPATE IN MEDIA RELATIONS OR INTERVIEWS On occasion, the Cobb County School District (the District) is approached by various media outlets and other outside organizations, companies or groups to interview, record or photograph District students for non-advertising purposes. These requests are approved by the District’s Communication Office or its designee. Once a student’s photograph, video image, audio clip, quote or other identifying information is published by media outlets or other outside organizations, companies or groups, it can be publicly accessed by individuals on or off campus. A student may be asked by the media outlet, outside organization, company or group to provide personal information, such as the student's full name, parents’ names, addresses, telephone number, or opinions on various topics. I understand that, although the District makes efforts to ensure that these interactions are positive, the District ultimately has no control over what information the media outlet, outside organization, company or group will obtain from the student, how the media outlet, outside organization, company or group will use the information gathered from the student, or how the student will be portrayed by the media outlet, outside organization, company or group. I hereby grant permission to the District to allow my student to be interviewed, photographed or recorded by media, including, but not limited to radio, television, and print outlets, or other outside organizations, companies or groups while on District property or at District events for non-advertising purposes. I also agree to indemnify, defend and hold harmless the members of the Cobb County Board of Education, the District, its officers, employees, agents, successors and assignees (the "Indemnified Parties") from and against any and all claims and liabilities resulting from this activity. Parents/guardians who do not approve of their child being interviewed should not sign or return this form to the school. Parents/guardians/students 18 or older should not sign if the “Subject/Nature of Event” and/or “Involved Media Outlet/Group” lines are not filled in below. Date Communications Office Contacted: Event Date: 1/31/13: Communications *JG2-1* Page 1 of 2
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Form JG(1)-2 Empowering Dreams for the Future
PERMISSION TO ALLOW STUDENT TO PARTICIPATE IN MEDIA RELATIONS OR INTERVIEWS
On occasion, the Cobb County School District (the District) is approached by various media outlets and other outside organizations, companies or groups to interview, record or photograph District students for non-advertising purposes. These requests are approved by the District’s Communication Office or its designee. Once a student’s photograph, video image, audio clip, quote or other identifying information is published by media outlets or other outside organizations, companies or groups, it can be publicly accessed by individuals on or off campus.
A student may be asked by the media outlet, outside organization, company or group to provide personal information, such as the student's full name, parents’ names, addresses, telephone number, or opinions on various topics. I understand that, although the District makes efforts to ensure that these interactions are positive, the District ultimately has no control over what information the media outlet, outside organization, company or group will obtain from the student, how the media outlet, outside organization, company or group will use the information gathered from the student, or how the student will be portrayed by the media outlet, outside organization, company or group.
I hereby grant permission to the District to allow my student to be interviewed, photographed or recorded by media, including, but not limited to radio, television, and print outlets, or other outside organizations, companies or groups while on District property or at District events for non-advertising purposes. I also agree to indemnify, defend and hold harmless the members of the Cobb County Board of Education, the District, its officers, employees, agents, successors and assignees (the "Indemnified Parties") from and against any and all claims and liabilities resulting from this activity.
Parents/guardians who do not approve of their child being interviewed should not sign or return this form to the school. Parents/guardians/students 18 or older should not sign if the “Subject/Nature of Event” and/or “Involved Media
Outlet/Group” lines are not filled in below.
Date Communications Office Contacted: Event Date:
Subject/Nature of Event:
Involved Media Outlet/Group:
Name of Student (Please Print) Signature of Student
Must appear if the student is 18 years of age or older Date of Student Signature
Name of Parent/Guardian (Please Print) Signature of Parent/Guardian
Date of Parent/Guardian Signature(s)
1/31/13: Communications *JG2-1* Page 1 of 1
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