Vernon Township School District
P.O. Box 99
Vernon, NJ 07462
973-764-2900
PHOTOGRAPHY & MULTIMEDIA CONSENT FORM
In compliance with New Jersey State Legislature Bill A592, Vernon Township School
District is requesting permission for your child’s photo/image and personally identifiable
information to be published for district use. The district would like to celebrate student
work and achievements on our website, district social media, local newspapers, and
other district multimedia. As you are aware, there are potential dangers associated with
the posting of personally identifiable information on the internet. The law requires that
we ask for your permission to use information about your child.
Pursuant to law, we will not release any personally identifiable information without prior
written consent from you as a parent or guardian. If you, as the parent or guardian,
wish to rescind this agreement, you may do so at any time in writing by sending a letter
to the principal of your child’s school and such rescission will take effect upon receipt by
the school.
Please check one of the following choices:
YES – I do grant Vernon Township School District permission to use
my child’s photo/image for uses stated above
NO – I do not want my student photographed for any reason except
class pictures
Student’s Name (please print) _______________________________________
Student’s School ______________________ Student’s Grade ____________
Print name of Parent/Guardian (print) _________________________________
Signature of Parent/Guardian (sign) __________________________________
Relation to Student ____________________________ Date _____________