Directions:  Complete a single section only (EITHER option 1 OR option 2 OR option 3).
Send completed form to Kenston Forest School, FAX (434) 292-7455

1

I grant permission for a photo/image that includes this student to be published on the Kenston Forest School public internet site, provided the photo/image does not include the student's name.  Individual as well as group photos/ scenes/ settings are authorized.

     Student Name (print)____________________________________
     Parent / Guardian Name (print)____________________________
     Relationship to Student (print)_____________________________

     Parent / Guardian Signature______________________________
 

2

I grant permission for a photo/image that includes this student to be published on the Kenston Forest School public internet site, provided the photo/image does not include the student's name.  Group photos/ scenes / settings are authorized, but individual photos / scenes / settings are NOT authorized.

     Student Name (print)____________________________________
     Parent / Guardian Name (print)____________________________
     Relationship to Student (print)_____________________________

     Parent / Guardian Signature______________________________
 

3

I do NOT grant permission for an identifiable photo/image of this student to be published on the Kenston Forest School public internet site, even if the student's name is not included.

     Student Name (print)____________________________________
     Parent / Guardian Name (print)____________________________
     Relationship to Student (print)_____________________________

     Parent / Guardian Signature______________________________
 

KFS Form R2         11 Mar 07                                     KENSTON FOREST SCHOOL