Student Media Waiver (Opt Out)
2018-2019 School Year
During the school year, your student may be part of activities or events that are photographed. The district may want to use your student's name and/or photograph for educational and promotional purposes on the district website, local cable television, newsletters, multimedia projects or other publications. In addition, each school publishes student names and photographs in their yearbook.

Parents/guardians may request their student's name and photograph NOT BE RELEASE OR USED by submitting this form.

Student Name (first, middle initial, last) *
Your answer
School *
Grade *
Please specify:
District website, local cable television, newsletters, multimedia projects or other publications
District social media such as Facebook, Twitter or YouTube
School yearbook, published by the school
Classroom Communications
Individual classrooms may choose to use a variety of tools other than those listed above, for distribution to families with a classroom or group on a smaller scale. You will be notified and asked for permission for your child to participate.
Parent/Guardian Name *
Your name typed below shall act as your signature related to this form.
Your answer
Today's Date *
MM
/
DD
/
YYYY
Submit
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