STUDENT MEDIA CONSENT AND RELEASE OPT-OUT FORM
At various points throughout the year, or during summer programs, district staff, the media, or other organizations, with the approval of the school principal, may take photographs of students, audio/videotape students, or interview students for school related stories. Those photographs, audio recordings and/or videotaped images or interviews may appear in district publications, in district video productions, on the district/school website, on district approved social networking accounts such as Facebook or Twitter, or in the news media, including print and/or online newspapers and/or magazines, radio and/or television news sites.
The Media Consent and Release grants:
A. Permissionforaphoto/imagethatincludesstudentswithoutanyotherpersonalidentifierstobepublishedonthe district and/or school’s website and social media platforms, as well as sent in press releases to area media and publicity outlets and publications and/or public presentation venues or displays.
B. Permissionforstudentname,photo/image,and/orschool,and/orgrade,aswellasimagesofstudent’srecognized art or academic awards/achievements to be published on the district and/or school’s website and social media platforms, as well as sent in press releases to area media and publicity outlets and publications and/or public presentation venues or displays as outlined in the administrative procedures for Board Policy S-2: Student Records, Privacy Rights, and Release of Information, Section I.D.
This information and these images are generally not considered harmful or an invasion of privacy if released. However, certain families or individuals may not want to have their child’s information released, and they are allowed to “opt out” under the Family Educational Records Privacy Act (FERPA).
To deny the use of your student’s photograph, video/audio, or interviews on district websites or in the media, please complete and submit this form to your school principal within 20 days of enrollment. This opt out must be completed annually. The form may be submitted at any time during the year if a parent wishes to “opt-out” of giving Media Consent.
Student’s Name: ___________________________________________ Grade Level: _______________ (Please Print Name)
Signature: (Parent, Guardian, or Eligible Student) Date:
By signing and returning this form to [my school district], I formally state that I deny the release of my/my student’s photographs, audio, video, and/or interviews for use on district websites, social media, and/or to the news media as indicated above.I deny the release of my/my student’s photographs, audio, video, and/or interviews for use on district websites, social media, and/or to the news media as indicated above.