- COMPLETED PHOTO RELEASE FORM

four
placed in Ms Racanelli/Ms. Rubino’s mailbox in the main office or in room
411. Key Club officers will not be held liable for them.
 MONTVILLE TOWNSHIP HIGH SCHOOL

CODE OF CONDUCT

We have read and understand the Code of Conduct of Montville High

School and agree to comply.

We also understand that participation in extracurricular activities is a

privilege and that we are representing Montville Township High School.
Montville Township High School recognizes that actions, both positive
and negative, reflect directly on our school and organization. We
understand that consequences may follow as a result of violations of
this Code of Conduct.

I _____________________________
Student Name wish to participate in the

following activity ________Key Club________ for the 2009-

2010 school year.

I UNDERSTAND THAT I MUST PERFORM 50

HOURS OF COMMUNITY SERVICE FOR THE YEAR.

_____________________________
Print Student’s Name

Date: ___________ Student

Signature:__________________________
Date: ___________ Parent/Guardian

Signature:__________________________

Please sign and return this page only and not the
actual code pages.
 Montville Township Public Schools
Parental/Guardian Consent Form
Photos and Videos for Public Release Including the Internet

I am sending you this letter to inform you and to request your permission for your child’s
photo/image and/or videotaping of personally identifiable information to be published on
the Montville Township School District Internet site.

As you are aware, there are potential dangers associated with capturing
personally identifiable information since global access to the Internet or viewing
of a videotape or cable program does not allow us to control who may access
such information. These dangers have always existed; however, we as a school
system do want to celebrate your child and his/her work. The law requires that we
ask for your permission to use information about your child.

Pursuant to law, we will not release any personally identifiable information without prior
written consent from you as parent or guardian. Personally identifiable information
may include one or more of the following: student name, photo or image, school
address, e-mail address, and locations and times of Montville trips and classes
and events.

If you, as the parent or guardian, wish to rescind this agreement, you may do so at any
time in writing by sending a letter to the classroom teacher and such rescission will take
effect upon receipt of the letter.

Check ONE of the following choices:

1. I/We GRANT permission for this student’s photo/image/videotaping, name and
school listed below to be published on the Montville Township School District Internet
site and/or other media, e.g. press release.

2. I/We DO NOT GRANT permission for photo/image/videotaping that includes this

student to be published on the Montville Township School Internet site and/or other
media.

Photo(s)/image(s) posted on the Internet will appear on the Montville Township website
at www.montville.net/highschool/keyclub
______________________________________________________________________

Student’s Name: (please print) ___________________________Student’s Grade: ___________

Student’sSchool________________________________________________________________
Print name of Parent/Guardian: (Print) ______________________________________________
Signature of Parent/Guardian _____________________________________________________
Relation to Student: _________________________ Date: ____________________________