Permission Form

As a pre-service teacher, I am requesting your permission to be able to take

photos and video of your child while they are working in the classroom for my
teaching portfolio. This portfolio will be presented to the Charles Darwin
University School of Education, and to a panel of educators at Grange Primary
School. Also, I am seeking permission to take photos of work the children will
do which will be prepared by me. I understand there may be cultural, family
and personal sensitivities and I will be respectful of this. By signing and
returning this form you have granted me (the pre-service / student teacher
from Charles Darwin University) and The Charles Darwin University School of
Education unrestricted right to use, reproduce and publish:

Photographs taken including image and likeness as depicted therein
Written works
Artworks
Video/audio recordings

Please fill out and return the following form if you feel comfortable in doing
so.

Thank you for your consideration to this matter.

Regards,
Bryan Birchall (student teacher).


Student Name............................................................................................

Parent/guardian name...........................................................................

Signature of parent/guardian..................................................................

Date......................