FOIP Consent Form - 2021

Consent to post or publish student information

To the parent(s) and/or guardian(s) of a grade 6 student at Webster Niblock School:
A request is being made by Megan McHale for permission to use your child’s personal
information (i.e., image, grade, and/or copies of student work) within an electronic portfolio used
for evidence of professional development. This portfolio will be accessible online, but will be
used solely for the purpose of demonstrating my teaching practice and providing evidence of
student involvement and success. Any images taken of students will be modified to ensure that
faces are blurred to avoid recognition. In addition, student names will not appear anywhere
throughout this portfolio to ensure anonymity.
By signing this form, you are agreeing that your child’s personal information may be used in the
following ways. Examples include, but are not limited to:
● Photo and/or video recording of students participating in class activities or demonstrating
learning
● Displays of student-completed work (i.e., completed projects/assignments)
● Incorporation of student photos and/or evidence of learning into a professional teaching
e-portfolio
Some websites used within the classroom for learning purposes may require students to login
and provide information such as their name, school, and email address in order to share their
work. This information will only be accessible by the student themselves, as well as the teacher.
By signing this form and returning it to the school, you are consenting to your child’s information
being used for the purposes described above. If no form is returned, it indicates that
consent was NOT given.

Please check the box that refers to your decision about your child’s information and fill
out the necessary information below.
❏ Yes, I consent to my child’s information being used for the above stated purposes.
❏ No, I do not consent to my child’s information being used for the above stated purposes.

Student’s Name: __________________________________________ Grade: __________

Parent/Guardian(s) Signature(s): _____________________________ Date: ___________________