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:
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New media (print media and film)
New media (print media and film)•Printing/publishing firms
Printing/publishing firms•Game films shared with other schools
Game films shared with other schools•College and post-secondary recruiters
College and post-secondary recruiters•School Booster clubs
School Booster clubs•School yearbooks, school newspapers, school printed programs
School yearbooks, school newspapers, school printed programs•District and school websites
District and school websites•Local, state, and national clubs and organizations
Local, state, and national clubs and organizations•Civic groups, business partners that choose to recognize and support student achievement
Civic groups, business partners that choose to recognize and support student achievementPLEASE 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
First and last name•Photographs or video images
Photographs or video images•Height, weight, and playing position
Height, weight, and playing position•Athletic performance statistics
Athletic performance statistics•Grade enrollment
Grade enrollment•School and district name
School and district name•Honors, recognitions, and awards at the local, state, and national level
Honors, recognitions, and awards at the local, state, and national levelInformation 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
______________________________________ ______________________________________
______________________________________PRINTED FULL NAME OF MY CHILD DATE SIGNED
DATE SIGNED