INTERVIEW/PHOTOGRAPHS/AUDIO/VIDEO CONSENT FORM
(As required by the Freedom of Information and
Protection of Privacy Act, Sections 32, 33 and 37)
This Consent Form must be used at
the time:
- when interviews are undertaken or when photos or videos are taken by the
media or an outside organization and where individual students
are identified by name.
- when photos or videos are taken by the Division or one of its schools,
where individual students are identified and the material is to be used for
purposes outside the school.
I hereby consent
for__________________________ (Name
of student) to be:
q
interviewed by
q photographed by
q videotaped by
q audiotaped by
___________________________________________________
Name of Organization (or Division Department)
Purpose of the interview, photograph or videotape and
what use will be made of it:
______________________________________
Signature of Parent/Legal Guardian
______________________________________
Date
For further information concerning the completion of this
form, please contact:
Mr. Ray Bosh, Associate Superintendent, Battle River Regional
Division #31, 5402 - 48A Avenue, Camrose, AB T4V 0L3 Phone: (780) 672-6131 Fax:
(780) 679-5013
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