Douglas County School District

Media Release Form

I hereby consent to the use of any photographs/video tape taken of my child by Douglas County School District or the media for the purpose of advertising or publicizing events, activities, facilities and programs of the Douglas County School District in newspapers, newsletters, school websites, social media sites (i.e. Facebook, Twitter, or YouTube), other publications, television, radio and other communications and advertising media.

Because of student privacy laws, we want to secure parental permission before publishing information about any child. Please understand thata child’s private information (such as addresses, phone numbers, social security number) isNEVERpublished by the school system, nor is it released to any other agency or media outlet. In the spirit of recognizing the achievements of our students, we print the student’s name and/or photo and award titles. However, we will only publish a student’s first name and first initial of last name (i.e. John S.) if it’s associated with a photo or video. The school yearbook would be an exception, as full names are printed in that publication. Please also understand we do not control what is produced by outside media sources.

From time to time representatives of the news media are invited to schools to cover events. When this happens there is a possibility your child/children may be photographed, videotaped, interviewed and identified for a news story.

Note:

  • This is a one-year agreement and can be changed in subsequent years
  • Failure to return this release form within ten (10) school days from the date of distribution will constitute approval of the above requests

Please mark one of the choices below and return to school.

_____ Yes, I allow my child/children to be identified in any good news school publication.

_____ No, I do not want my child/children identified in any good news school publication.

PLEASE PRINT

Student’s Name:

Address:

City:

State/Zip:

Signature:

Parent or Guardian if above person is under 18:

Parent/Guardian’s Name:

Address:

City:

State/Zip:

Signature:

Please understand that failure to return this release form within ten (10) school days from the date of distribution will constitute approval of the above requests.

Y:\Ed Services-Area 4\School Registration Packet\2016-17\English\11-Media Release Form.docxRev. 2/2016