Developing All-around
Players
www.DarellePorter.com
Internet
Image Use Consent Form
This consent form
allows me to publish photos and images of your child playing basketball or interacting with other students while in basketball
camps. With your permission, I will publish the image of your child. If you do
not want their name or other information to be published, please specify at the bottom of the form in the space provided.
As there are potential
dangers associated with internet publications, I take great precautions as to what is published. On the same note, the website can serve as a networking tool for families to share photos and successes
of your child with other family members and their friends.
Check one of the following:
£ I/We
give permission for my child’s photo/image only to be published on Darelle Porter’s website.
£ I/We give permission for my child’s photo/image and first name only to be published on Darelle Porter’s
website.
£ I/We give permission for my child’s photo/image, name, school, city, state, and any other personal
information to be published on Darelle Porter’s website.
£ I/We do not give permission for my child’s photo or any other information to be published
on Darelle Porter’s website.
Student’s Name |
Grade |
School |
Parent/Guardian (print) |
Signature of Parent/Guardian |
Relation to Student |
Date |