DPS 109 Photo/Video Opt-Out Form - 2022-2023
Photographs, videos, or voice recordings of students and staff are taken throughout the year for use on the district website, newsletters, and social media sites, as well as shared with local media outlets (both print and online). In addition, the District celebrates our students’ success by sharing news of notable achievements with the community. If you do not want your child photographed or videotaped for District 109 use, or their name included when they are honored for achievement, you must submit, in writing, a signed statement that you do not grant any publication permissions to District 109. 

THIS FORM IS REQUIRED TO BE FILLED OUT ON AN ANNUAL BASIS.

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Email *
Name of student: *
School/Program: *
Grade level for the 2022-2023 school year: *
Name of parent/guardian completing form:
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