We are sending you this parental consent form to both inform you and to request permission for your

child's photo/image and personally identifiable information to be published on the Montgomery Girls Basketball

As you are aware, there are potential dangers associated with the posting of personally identifiable information

on a web site since global access to the Internet does not allow us to control who may access such information.

These dangers have always existed; however, we do want to celebrate your child and her accomplishments.

The law requires that we ask for your permission to use information about your child.

Pursuant to law, we will not release any personally identifiable information without prior written consent from

you as parent or guardian. Personally identifiable information includes student names, photo or image, jersey

number, locations and times of games.

If you, as the parent or guardian, wish to rescind this agreement, you may do so at any time in writing by

sending a letter to the Montgomery High School Girls basketball Booster Club and such rescission will take effect

upon receipt by the club.

_______ I/We GRANT permission for this student's photo/image, jersey number and name to be published on the

Montgomerygirlsbasketball.com web site.

_______I/We DO NOT GRANT permission for photo/image that includes this student’s name and jersey number

to be published on the Montgomerygirlsbasketball.com web site.

Student's Name: (please print)__________________________________________Student's Grade:__________

Print name of Parent/Guardian: (print) __________________________________________________________

Signature of Parent/Guardian: (sign) ___________________________________________________________

Relation to Student: _________________________________________________________________

Date: ________________

email questions to: info@montgomerygirlsbasketball.com