Communications Release Form

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Throughout the school year, the MSD promotes various activities and achievements. Students may be
featured in materials to increase public awareness of our schools through newspapers, radio,
television, the web, and other types of media.

Email *

yes

Clear selection

یمنح الموقع أدناه إذنا بالموافق أو الرفض لطفلھ / طفلھا: *

نعم، أعطي الإذن لطفله: yes

لا إذن لطفله:no

Name of Child [First and Last Name] اسم الطفل: *

Grade *

School *

Bakersville

Beech

Gossler

Green Acres

Hallsville

Highland Goffe's Falls

Jewett

McDonough

Northwest

Parker-Varney

Smyth Road

Webster

Weston

Wilson

Hillside

McLaughlin

Parkside

Southside

Name of Parent/Guardian [Full Name, First and Last Name] This serves as your signature اسم الأصل/الوصي [الاسم الكامل، الاسم الأول والأخير] *

Send me a copy of my responses.

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