Media Opt-Out Form

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Media Opt-Out Form

OPTIONAL: Please use this form if you are a parent, student, or guardian that wishes to NOT consent to photo/video/etc. for your child.

Email *

Record my email address with my response

OPTIONAL

Complete only if you do not want the district to use your child in any photos for the website, media and promotional videos.

Greenburgh Graham Union Free School District’s policy is to allow photographs, video and audio recordings, comments, and/or names of students to be used in print and electronic materials produced by the District including but not limited to websites, printed publications, and video productions, unless notified of an objection by a student/parent/guardian.

The District may also release this content to media organizations, including newspaper, radio, and television outlets. Students may be identified by name to provide them with recognition opportunities when appropriate.

Students, parents and guardians may request that photographs, video and audio recordings, comments, and/or names of students not be used by completing this form and returning it to the student’s school office.

I do NOT consent to the above and wish to opt out my child out of photos and video.

I hereby request that Greenburgh Graham Union Free School District NOT use photographs, video and audio recordings, comments, and/or the name of this student in print or electronic materials. I further request that the District NOT release this student’s photograph, video or audio recording, comments, and/or name to media organizations.

Child's FULL name: *

Child's Date of Birth: *

Your full name: *

Your relationship to student: *

Parent/Guardian

Self

Other:

Your email address: *

Child's Home Address: *

Send me a copy of my responses.

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