Photograph/Video Opt Out Form

Photograph/Video Opt Out Form
Complete this form if you do NOT give permission for your student's image to appear in school publications, including postings on the Tri-Valley CSD website.

From time to time, photographs or videos of students are taken during the school day for use in District and educational news releases, publications, video productions, social media, educational projects, and the District website.

If you do NOT wish to have your child photographed/videotaped for news media or school publicity purposes, sign and return this form to your school building principal. Parents must complete this form by September 15 of each year or at the time of registration to the District. This form applies only to the current school year and must be filled out each year if you do not want your child's image published.
Student's Name:*

First NameLast Name
School Year:*
Grade:*
Parent/Guardian Name:*

First NameLast Name
ParentGuardian signature*

Clear
Date*

MonthDayYear
Date
If you would like a copy of this compeleted form, please provide your email below.
Email
example@example.com
Please note that if your student participates in public events (such as a sporting event or drama production that is open to the community) the school/district may have little or no control over photographs taken by media, other parents, or community members attending the event.

Students 18 years of age do not require parental consent for photo use. For more information, contact the District Office at (845) 985-2296.
Should be Empty: