Student Media Waiver (Opt Out)
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2023-2024 School Year
During the school year, your student may be part of events that are photographed. The district may want to use your student's name and/or photograph for educational and promotional purposes on the district website, local cable television, newsletters, multimedia projects or other publications. In addition, each school publishes student names and photographs in their yearbook. 

Parents/guardians may request their student's name and photograph NOT BE RELEASE OR USED by submitting this form.

Student Name (first, middle initial, last) *
School *
Grade *
District website, local cable television, newsletters, multimedia projects or other publications
District social media account(s) such as Facebook, Instagram, YouTube, etc.
School yearbook, published by the school
Internal School TV's, published by the school
Classroom Communications
Individual classrooms may choose to use a variety of tools other than those listed above, for distribution to families with a classroom or group on a smaller scale. You will be notified and asked for permission for your child to participate.
Notes: 
Please add an information that you feel would assist us in supporting your student and family with this topic. 
Parent/Guardian Name *
Your name typed below shall act as your signature related to this form.
Today's Date *
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