Professional Documents
Culture Documents
_____________________________________________
(Teachers Signature)
Grade: _____________________________________
School: ___________________________________________
Teacher: ____________________________________
As the parent/legal guardian of the child named above, please check one of the following options:
I DO give permission for the teacher named above to include any materials my child produces as part of classroom activities in
the teachers Professional Portfolio, in accordance with copyright regulations. I understand that limited identifying information may
appear on the materials in the teachers portfolio.
I DO NOT give permission for the teacher named above to include any limited identifying information of my child or any materials
my child produces as part of classroom activities in the teachers Professional Portfolio.
Print Name of Parent or Guardian:
_________________________________________
If this form is not completed and returned to the school it will be considered that you have not provided consent to
use your childs work samples and photographic images as described above
The information on this form is collected in accordance with the Freedom of Information and Protection of Privacy Act, Sections 33, 34, 38, 39,
40 and 41.