I give my permission to the Commack School District to publish the photograph of my child on the school district website and in the Commack Courier. I understand that my child’s last name will not appear on the website. The website address to which this permission is granted is located at http://www.commack.k12.ny.us.

_____ I Agree to having my child’s photo presented on the District Website and in the Commack Courier.

_____ I Do Not Agree to having my child’s photo/work presented on the District website and in the Commack Courier.

______________________________________________ __________________

Parent/Guardian Signature                                                             Date

__________________________________ ________________________

Print Name of Student                                         Birth Date

__________________________________   __________

School                                                                        Grade

Please send completed form to your child's teacher who will forward it to:
Commack Courier/Webmaster
Commack High School

updated 12/4/03