subject_line
Comsewogue School District
Media Opt-Out Form
Para completar este formulario en español, visite este enlace.
This form is only to be completed if you
do NOT want your child's picture included in any District media.
Student First Name
*
Student Last Name
*
School
*
Comsewogue High School
John F. Kennedy Middle School
Boyle Road Elementary School
Terryville Road Elementary School
Clinton Avenue Elementary School
Norwood Avenue Elementary School
Grade
*
K
1
2
3
4
5
6
7
8
9
10
11
12
Please
ONLY
check the box below
if you wish for your child's picture t
o
not be included in any District media
.
*
Comsewogue School District does NOT have permission to use my child's photograph in media publications that highlight the district's programs, including (but not limited to) newspapers, newsletters, digital displays, magazines, videos, television shows, social media and websites. I understand that my child will remain on the media opt-out list from year-to-year unless I submit, in writing, to the school district that my child be removed from the list.
Parent's First Name
*
Parent's Last Name
*
Today's Date
*
Parent Signature
*
clear