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Get Fillable Form 2483

SONOMA STATE UNIVERSITY Office of the Dean School of Education 707 664-2132 707 664-2483 FAX RELEASE FORM Sonoma State University PARENT/GUARDIAN RELEASE FORM FOR PHOTOGRAPHS FILMS SLIDES VIDEO AND AUDIO TAPE RECORDINGS OF PUPILS ENROLLED IN SCHOOLS Pupil s Name Classroom Teacher Grade School School Year You have my permission for film video and audio tape recordings slides and photographs to be made of my son/daughter in classroom activities assessment and other school activities. I understand that the films video and audio tape recordings slides and/or photographs are being produced for educational purposes for the student teacher working in my student s classroom* Such records shall only be used for the following to record and evaluate the Student Teacher/Credential Candidate teaching students in their classroom placement. Such record will be used as part of a performance assessment of the candidate by Sonoma State University that is required by State law. Yes I give my consent. No I do not give my consent. Parent/Guardian Signature Date After signing please return to your child s teacher. I understand that the films video and audio tape recordings slides and/or photographs are being produced for educational purposes for the student teacher working in my student s classroom* Such records shall only be used for the following to record and evaluate the Student Teacher/Credential Candidate teaching students in their classroom placement. Such record will be used as part of a performance assessment of the candidate by Sonoma State University that is required by State law. Such record will be used as part of a performance assessment of the candidate by Sonoma State University that is required by State law. Yes I give my consent. No I do not give my consent. Parent/Guardian Signature Date After signing please return to your child s teacher. I understand that the films video and audio tape recordings slides and/or photographs are being produced for educational purposes for the student teacher working in my student s classroom* Such records shall only be used for the following to record and evaluate the Student Teacher/Credential Candidate teaching students in their classroom placement. Such record will be used as part of a performance assessment of the candidate by Sonoma State University that is required by State law. Yes I give my consent. No I do not give my consent. Parent/Guardian Signature Date After signing please return to your child s teacher.

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