VISUAL ARTS Permission Form
School:
Student’s Grade Level:
STUDENT INFORMATION
Student Name: (First)
Student Name: (Last)
Student Address:
City, State, Zip:
Teacher Name: (First)
(Last)
DESCRIPTION OF PIECE:
Title:
Category: Painting Drawing Mixed Media Digital Art Photography 3D
CONSENT TO RELEASE AND DISPLAY STUDENT WORK PRODUCT:
From time to time, the Bossier Parish School Board (“Board”) participates in public forums or displays for purposes of touting, or showcasing, the academic or
artistic achievements of students enrolled in the Bossier Parish School System. Traditionally, the School Board’s participation in these events have involved the
showcasing and displaying of artwork, video productions, photographs, or other artistic works created by our students.
The School Board is interested in showcasing, to the public, certain artistic creations developed by your child. If you would like for your child’s creation to
be showcased to the public, you must provide your consent indicating your approval.
_______________________________________________________________________________________________________________________________________
Please Read Carefully_
I hereby consent to the display of my child’s work product (whether photographs, videos, or otherwise) in any public forum or display (physical or
electronic) in which the School Board chooses to sponsor or participate. I understand that the display of my child’s work will also include the display of my child’s
name, image, or other identifying information. I acknowledge that my consent to the display of my child’s work product is voluntary and that no compensation will
be paid to either me or my child. I acknowledge and agree that once the work product is displayed, I will not be able to revoke this consent.
Statement of Originality: I certify that this is an original work of art as outlined in the Entry Guidelines and that all work was completed by the above listed
student. Student Signature: Date:
Parent/Guardian Signature: Date:
Teacher Signature: Date:
-------------------------------------------------------------------------------------------------------------------------------------------------------
School:
Student’s Grade Level:
STUDENT INFORMATION
Student Name:
Category: (See Above)
Title of Artwork: (required)