ACT 837 PARENT/GUARDIAN CONSENT FORM
Student Participation in Athletics

Dear Cameron Parish Parent and /or Guardian,

In 2014, the Louisiana Legislature passed Act 837 which places new restrictions on the transfer of personally identifiable student information. However, the nature of participation in athletic programs provides opportunities for our student to receive public recognition by sharing some personally identifiable information with groups inside and outside of the school such as:

New media (print media and film)
Printing/publishing firms
Game films shared with other schools
College and post-secondary recruiters
School Booster clubs
School yearbooks, school newspapers, school printed programs
District and school websites
Local, state, and national clubs and organizations
Civic groups, business partners that choose to recognize and support student achievement

PLEASE READ AND SIGN BELOW

I verify that I am the parent/guardian of the child listed below, I acknowledge the fact that my child participating in athletic programs may require that information about my child may be shared with groups or organizations inside and outside of the school. I give permission for some or all of the following information to be shared as a result of my child’s participation:

First and last name
Photographs or video images
Height, weight, and playing position
Athletic performance statistics
Grade enrollment
School and district name
Honors, recognitions, and awards at the local, state, and national level

Information regarding academic eligibility for participation in athletics
I give permission to the Cameron Parish School System, my child’s school, athletic team or program coaches to share my child’s personal information to the groups listed above.



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PRINTED NAME OF PARENT/GUARDIAN                                                     SIGNATURE OF PARENT/GUARDIAN



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PRINTED FULL NAME OF MY CHILD                                                            DATE SIGNED