70 Waterford Street
Gardner, MA 01440
Telephone (978) 632-1000
FAX (978) 632-1164
Attached to this Web Page Publishing Permission Form
is a copy of the Web Site Guidelines and Procedures for Approval Policy. Please carefully read this policy before
completing this permission form.
Parents/Guardians must indicate on this form whether
they grant or deny permission for their child’s first name, last
initial, grade and/or picture to appear on the school’s Web page(s).
If a parent/guardian fails to complete the form, the
school will treat that act as an approval of consent, until otherwise notified
in writing by the parent/guardian.
This permission form will be kept on file at the
student’s respective school.
If the student is eighteen, he/she may sign the
permission form.
Student telephone numbers, last name and/or home
addresses will not be posted on any Gardner Public Schools Web page.
Student Name: ______________________________________________________
Student’s School:
____________________________________________________
_____ I grant permission to publish Web page
information on the above-named student.
_____ I deny permission to publish Web page
information on the above-named student.
Parent/Guardian Signature: ____________________________________ Date: ______________
[Revised: July 2006]