Student Information, Behavior Contract, and Parental Consent
FOLSOM HIGH SCHOOL MEDIA PRODUCTIONS
Mr. Scott Southard
Instructor
355 1174 Ext 3803
ssouthar@fcusd.org
PLEASE PRINT SO THAT IT’S EASY TO READ!
PARENT/GUARDIAN SIGNATURE REQUIRED!
CLASS PERIOD ____YEAR ________
STUDENT:
LAST NAME _______________________________________FIRST ________________________ GRADE ____
CELL # _____________________________ EMAIL _________________________________________________
PARENT/GUARDIAN:
NAME(S)____________________________________________________________________________________
PHONE _______________________________________EMAIL________________________________________
PARENT/GUARDIAN PLEASE READ WITH YOUR STUDENT AND SIGN BELOW
A.
Students in Media Production Classes will be video and audio recorded. Students likeness and/or voice may
be used by the Folsom Cordova School District for legitimate learning and promotional purposes. Students
may appear on closed circuit campus television, community broadcast television and in short films prepared by
classes for submission to student film festivals. By signing below you acknowledge and consent to these
conditions and agree to hold harmless the Folsom Cordova Unified School District or its employees or
representatives for any responsibility or liability on account of broadcast or viewing as described.
B.
Media Production Students are trained using a variety of expensive equipment such s, but not limited to, digital
video cameras, lights, sound mixing boards, and computers. Students are trained in the safe and proper use of
equipment and are expected to use the equipment this way. In the event of theft, intentional breakage, misuse,
or destruction through negligence, students and their parents/legal guardians may be held financially
responsible for replacing equipment. By signing below you acknowledge and consent to these conditions.
C.
Students will use and have access to networked computers in the Media Lab. Students are to abide by
classroom rules as printed in the Course Expectations and by campus rules regarding appropriate use of
computers and the internet (PAWS book pg 26). Students are to use the computers and internet ONLY for
assignments purposes. By signing below you acknowledge and consent to these conditions.
D.
Media Production students will view a variety of media examples in the classroom. Some material will be
from award winning films with an R rating or from television programs originally intended for mature
audiences or MA14. Every effort is made to show only scenes appropriate for high school students, or to show
edited versions of shows, scenes, and films. By signing below you acknowledge, permit, and consent to these
conditions.
E.
Media Production students must provide some of their own materials for class and in some classes must pay
film festival admission and submission fees of $15. Please see the course description for details of the needs
for your particular class.
By signing below you acknowledge that you have read the above and understand the course description and
materials requirements.
STUDENTS SIGNATURE __________________________________________________________DATE_______
PARENT/GUARDIAN SIGNATURE__________________________________________________DATE_______