File:  JRA/JRC-E-3






Opt-Out Form for Student Image Publishing


Classroom activities and school events are sometimes photographed or videotaped by the school or media groups (newspaper, television, university, district public relations, etc.) In addition, the district or school may want to post articles, video or photography on district or school websites.


This form applies to classroom activities and school events that are not open to the public. Public events such as sporting events, theatre productions, etc. are open to the public and are not covered by this form.


If you DO NOT want your child’s photograph, video and/or electronic image to be published for news media or school publicity purposes, please complete this form and return it to your child’s school by __[insert specific date]__.



[  ] I do not wish to have my child photographed or videotaped for purposes of news coverage or school district publicity.


Signature of parent/guardian  ___________________________________________


Student's name  _____________________________________________________


School  ____________________________________________________________


Student’s current grade level  _____________


Date  _________________


This form applies for the current school year.


Adoption date: September 22, 2014