6141.324 Form

SEYMOUR PUBLIC SCHOOLS

Seymour, Connecticut

Parent Permission Form for World Wide Web Publishing of Student Work

Name of Student______________________________________

School _______________________________ Name of Parent ____________________________________

We understand that our daughter or son's artwork or writing is under consideration for publication on the World Wide Web, a part of the Internet.  We further understand that the work will appear with a copyright notice prohibiting the copying of such work without express written permission.  In the event anyone requests such permission, those requests will be forwarded to us as parents.  No home address or telephone number will appear with such work.

We grant permission for the World Wide Web publishing as described above until_______________.  A copy of all such publishing will be printed out and brought home for us to see.

Signature ____________________________________________ Date ____________

Signature ____________________________________________ Date ____________

I, the student, also give my permission for such publishing.

Name _______________________________________________ Date ____________