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
Email *
PARENT/GUARDIAN FULL NAME (First and Last) *
STUDENT FULL NAME (First and Last) *
Student Grade
Parent Email  *
Parent Phone Number *
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. *
Required
DLHS has permission to photograph or digitally record my child for media and web publication. *
Required
My child has permission to be photographed or digitally recorded by the news and other non-DLHS media.   *
Required
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