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Media Consent and Security Notice 2021-2022

Please complete the form below. Required fields marked with an asterisk *

Media Consent and Security Notice

Student Last Name*

Answer Required

Student First Name*

Answer Required

Community Access Cablevision, Photographs, Videotaping, Interview Comments, and Posting on the Internet

Occasionally, the school may use the name, photograph(s), video recording, and/or interview comments of students for educational and promotional purposes, including news articles and brochures. As part of each school’s parent/community informational program, a school may wish to place students’ pictures and/or names on the Internet or the school’s web page. All photography, video recording, student comments, and posting on the Internet is done by legitimate news media personnel or School personnel. In order to use such material, parental consent is necessary for any student under 18 years of age.

I hereby give my consent to ASA Charter School to show, take, or authorize others to take: *

(please check all that apply)

Answer Required

Yes I DO want my child to be photographed or filmed by members of the media, organizations or agencies at school, for use in print or Internet publications, documentaries, films or video, to the extent that the school can prevent such contact.

No I DO NOT want my child to be photographed or filmed by members of the media, organizations or agencies at school, for use in print or Internet publications, documentaries, films or video, to the extent that the school can prevent such contact.

Movie Release

I hereby give my consent to ASA Charter School to show the following videos or movies: *

(please check all that apply)

Answer Required

Yes I DO allow my child to watch Videos or Movies rated G or PG. (PG-13 and above require individual permission slips which will be provided before the time of showing.)

No I DO NOT allow my child to watch Videos or Movies rated G or PG. (PG-13 and above require individual permission slips which will be provided before the time of showing.)

I understand that these pictures may be used for educational, public interest, or informational purposes through media of radio, television, newspaper, or film.

Name of Legal Parent/Guardian or Student *

(Please type your full name here)

Answer Required

Signature of Legal Parent/Guardian or Student *

(Please type your full name here)

Answer Required

Security Cameras

ASA Charter School is committed to providing a safe and secure school for all of our pupils and staff, we regularly video record during the school day, after hours and on weekends. To effectuate the School’s goals to ensure the health and safety of all students and staff, and to protect school property, the School has installed digital security camera systems on our school site. The system does not monitor classrooms, except those located in the computer lab. Security cameras concentrate on entry and exit areas, hallways, library, cafeteria, playgrounds, parking lots and other areas of the school that are subject to damage, graffiti or the unauthorized entry of persons or groups. We are working closely with local law enforcement agencies to assist us. All cameras are being installed in easily seen locations and there are no “hidden” cameras. Only authorized site administrators, security and law enforcement personnel have access to the camera images

Unlike the above media policies, there is no opt out policy for security camera recording. I understand that the surveillance cameras are used to ensure the health and safety of all students and staff and to protect school property.

I understand that the surveillance cameras are used to ensure the health and safety of all students and staff and to protect school property. *

(Please type your Initials here)

Answer Required

Thank you for taking the time to fill out this form. We look forward to working with you to help your child be successful in school!

Confirmation Email

Confirmation Email *

Email Required