FUTURE BUSINESS LEADERS OF AMERICA MERCER COUNTY COMMUNITY COLLEGE 1200 Old Trenton Road PO Box B Trenton NJ 08690 (609) 570-3766
2009-2010 Parent/Guardian Media Consent Form New Jersey FBLA is creating programs to highlight chapter activities. A new program (Media Spotlight) will allow chapters to submit video and photos of its chapter activities (fundraisers, community service, events, etc.). This form is to request permission for your child's name and photo or video to be published on the New Jersey FBLA web site, www.njfbla.org. Pursuant to law, we will not release your child's name and photo or video without prior written consent from you. In recognizing FBLA member and chapter achievement, your child's name, photo, or video associated with his/her school, may be published on the web site. If you wish to rescind this agreement you may do so at any time by sending a letter to the NJ State FBLA Chairman, Ellen Benowitz, MCCC, PO Box B, Trenton, New Jersey 08690.
Please complete the following information and mail or fax this form to the NJ State FBLA Office at 609-570-3887.
_____ I GRANT permission for my child's name, photo or video to be published on the NJ FBLA web site.
________________________________________________________________________________ (Student's Name) ________________________________________________________________________________ (Name of School) ________________________________________________________________________________ (Name of Parent/Guardian and Relation to Student) ________________________________________________________________________________ Signature of Parent/Guardian Date
PHI BETA LAMBDA, INC.
NEW JERSEY STATE CHAPTER