MEMORANDUM 


FORM PREVENTING THE USE OF PHOTOGRAPHS AND/OR VIDEOTAPES OF STUDENTS 
OUTSIDE OF THE DISTRICT AND/OR ON THE DISTRICT’S WEBSITE 

Student Name ___________________________________________Current grade _____________ 

School _______________________________ Student ID # ___________ Birth date ___________ 

Dear Parents/Guardians: 

From time to time our school and the school district make videotapes and photographs of our students and their 
school work. When we do this for normal school use within the school district, we do not require parent 
permission. Occasionally, videotapes and photographs of our students, their class activities, and their student work 
are used outside of the district and on our websites. Examples of these uses are: to show the Bellevue community 
what we do in our schools; to include in broadcast media and newspaper articles, the Annual School Performance 
Report, and Bellevue Schools Foundation programs; to televise through the City of Bellevue Cable TV station; to 
make presentations to other audiences at workshops; to post on our district, school, teacher, and curriculum 
websites along with lesson plans; and to use in a variety of other appropriate district-authorized purposes. 

Your student might be included on videotapes or in photographs that could be used for such activities, unless you 
object. Only if you do not want videotapes and/or photographs of your child and his/her student work to be 
released for such purposes, please check the applicable boxes, sign below, and return this form to the office at your 
child’s school. Otherwise, such use will be allowed. 

. I do not want my student’s photograph (and/or digital image) or school work posted on the district’s 
websites, which include the district’s main website, school, teacher, and curriculum websites. 
. I do not want my student included in any photographs, videotapes, and/or digital reproductions for any use 
outside of the district’s own activities, such as for Bellevue Schools Foundation, university, City of 
Bellevue presentations, or for any other audiences at workshops, or for use in the newspapers, television, 
or other media. 

Parent or Guardian Name ____________________________________________________ 

Parent or Guardian Signature _________________________________________________ 

Student Signature (if student is 18 or older) _________________________________________ 

Date ______________ 

PLEASE NOTE: Parents/guardians do not need to fill this form out every year – this information will remain valid 
and in effect until changed by the parent/guardian. 

The district cannot guarantee the complete removal of a student’s information from every site on the Internet, due to 
the ease of creating links to and copying material from the Internet. 

Rev. 7/08