Date________________

Dear Parent:
It is our library's practice when preparing work for external publications or on the Internet to seek parent permission before including your child’s photo. In order to include your child’s photo in the project described below, we must have your signed permission. Names of children will not be used on Internet projects. Please review the information, sign the form, and return it to the library.

Please sign and return to the library.

Staff Person______________________________ has my permission to publish a photo of my child_______________________________ for an external publication _________________ (date) on the Internet.

I hereby give permission to (library) ____________________________________ to use my child’s photo for online publication. In granting permission, I also understand that my child’s name will not be published on the Internet.

Parent Signature________________________________ Date__________________

Daytime Phone_______________________ Evening Phone________________