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Pine Island Academy Contact Information Release
Complete this form to allow or decline permission to use your email address and/or phone number with your classroom for parent involvement and/or grade-level activities.

Please complete ONE FORM PER STUDENT.
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Parent / Guardian First Name *
Parent / Guardian Last Name *
Do you give permission for your email address and/or phone number to be used by your classroom? This information will only be used to communicate information regarding opportunities for parent involvement and/or grade-level activities. *
PTO Student Information and Image Consent
Our PTO produces a number of publications and projects intended to encourage community spirit and interaction and to recognize students and their achievements. In order for your student's name and/or photograph to be included in these publications, the PTO must receive your written consent. All students may have the opportunity to be included in these publications. If you do not want your student's name and/or photograph to be included in the publication and/or project, mark the item "No" and every reasonable effort will be made to omit your child's information and image from these publications/projects.
PTO Website (Mark Yes or No) *
PTO Newsletter (Mark Yes or No) *
Facebook (Mark Yes or No) *
Instagram (Mark Yes or No) *
Other Media (Mark Yes or No) *
Grade & Teacher's Last Name *
Email Address for Release *
Phone Number for Release
Student's First Name *
Student's Last Name *
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