Somerville High School 222 Davenport street

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Office of Technology & 21st Century Education

Student Information/Image Release Form

Dear Parent/Guardian,

We want to celebrate your child!
Somerville students continually amaze us with their creativity and academic overachievement. We want to showcase your child and their exceptional work in every way we can. In the coming academic year, we will be posting student work on our webpage, in newspapers, and in other venues.
Below, we ask that you kindly grant your consent for us to publicly celebrate all of the great things your child does here at Somerville Public Schools.
Thank you; the support you give your child and his/her school makes all the difference!
Yours in education,

Jason Solomon

Director of Technology & 21st Century Education

Somerville Public Schools

51 West Cliff Street

Somerville, NJ 08876

O 908-243-1579

C 908-295-5312

I hereby grant my permission for my child’s image and/or their work to be published in the following ways:

  1. On school websites Yes☐ No☐

  2. In print media Yes☐ No☐

  3. In television broadcasts Yes☐ No☐

  4. On press websites Yes☐ No☐

My child’s name_____________________________________ School__________________

Parent/Guardian signature ___________________________Printed Name_______________
Contact email address___________________________ Phone Number_________________


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