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DLHS MEDIA PERMISSION FORM
Please fill out the form below, indicating whether permission of the parent/legal guardian is given for the student's picture and/or name to appear in the media.
Media includes: Newsletters, Website, District Social Media
* Indicates required question
Email
*
Your email
YOUR FULL NAME (First, Last)
*
Your answer
STUDENTS *FULL* NAME
*
Your answer
Email
*
Your answer
Phone number
*
Your answer
I confirm or deny my child’s participation in the areas identified with a check mark below:
DLHS has permission to honor my child publicly, including in the media.
*
YES
No
Required
DLHS has permission to photograph or digitally record my child for media and web publication.
*
YES
No
Required
My child has permission to be photographed or digitally recorded by the news and other non-DLHS media.
*
YES
No
Required
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