Media Consent 2015-2016 Student Name: MEDIA CONSENT AND RELEASE: Students at WMS are occasionally asked to be a part of school publicity, publications, and public relations materials and programs (including but not limited to print, web and video). In order to guarantee student privacy, Western Mennonite School requires parent/guardian authorization permitting its use of student information. By signing below, I give Western Mennonite School permission to use information about my student in school publicity, publications, and videos or on the school’s website. Information includes, but is not limited to, student’s name, picture, art projects, written work, voice, verbal statements or portraits (video or still). I understand that this information may be used in subsequent years. Parent/Guardian Signature ________________________________________________ Hometown Newspaper ___________________________________________________ If you do not want WMS to use student information in specific areas, please indicate what you do not authorize below:
NOTICE REGARDING DIRECTORY INFORMATION: I hereby give consent for the student’s grade level and parent’s address and phone number to be listed in the school directory. ☐ YES ☐ NO If NO, please send a written request to the school.
Church Attendance We currently attend a church ☐ YES ☐ NO
Denomination __________________________________________
Name of Church _____________________________________________ City _________________________________ Pastor __________________________________ Youth Pastor _____________________________________________
Parent Volunteers If you are interested in volunteering at Western please fill out the following information and you will be contacted accordingly. Parent/Guardian Name: Home Phone:
Cell Phone:
E-Mail:
___ Bulletin Boards
___ Field Trip Chaperone
___ Benefit Auction (May)
___ Parents in Prayer
___ Drama Support
___ Photography
___ Golf Tournament (Sept.)
___ Student Grant Phonathon Caller
___ Grounds/Facility Maintenance
___ Office Support
___ Hospitality Home (Host international students for extended weekends/year. ____ Male ____ Female) Find more opportunities online at www.WesternMennoniteSchool.org/volunteers