Student Do Not Publish Form
DO NOT PUBLISH FORM FOR DISTRICT USE OF PHOTOS/VIDEO CLIPS/INTERVIEWS/WEB PAGES/STUDENT WORK 

During the 2023-2024 school year, photographs, school activities or sports video clips, interviews, and/or student work involving your child may be used in school newsletters, the District web page, or area newspapers. The Millbrook Central School District is providing you with this DO NOT PUBLISH Form if you DO NOT wish to have your child’s image, quotations, or work utilized in school district publications or press releases.

ONLY submit this form IF you DO NOT permit us, as you indicate below.

If you DO NOT want your child's photo, video, interview, web pages or student work published, complete the information below by September 6, 2023, the opening day of school.

ACTION REQUIRED ONLY IF YOU DO NOT GIVE PERMISSION!
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Email *

I, the undersigned parent/guardian of

Please note, you will need to complete this form for each child you do not want having their photo, video, interview, web pages or student work published.

 *
Type your child's first and last name.
School your child attends *
Check only one box.
Child's Grade *
Homebase Teacher's Name
Classroom Teacher's Name *

DO NOT GIVE MY PERMISSION FOR THE USE OF HIS/HER:

 *
Please check each item below for which you specifically do not give permission.  If you change your decision after filling out this form, it will be your responsibility to contact the school about the change.
Required
Electronic Signature *
By typing your full name below, you are requesting your child's  photo, video, interview, web pages or student work NOT be published.
A copy of your responses will be emailed to the address you provided.
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