Media Objection Notice

The District strives to promote the many positives occurring daily in our classrooms. Media coverage of public
events in which students of the District are participants is welcomed and encouraged. Pictures and video may also be captured to use for marketing purposes.

A parent/guardian will be given an opportunity to opt a student out of such exposure by completing the Media
Objection Notice form. The form must be completed by September 8, 2023. The District will recognize only those options to “opt out” that it receives in writing, and makes no representations regarding media access to such students other than that the District will use reasonable measures to ensure that any student who has exercised such an option is not exposed to media coverage.

This form is good for one school year and must be filled out each year in order to keep the objection notice in place.

Student Information *

	First Name	Last Name
Student 1	First Name	Last Name
Student 2	First Name	Last Name
Student 3	First Name	Last Name
Student 4	First Name	Last Name

Student School and Grade

	School		Grade
Student 1
Student 2
Student 3
Student 4

By signature below indicates that I object to my child's name, picture, or likeness being used by the District for marketing purposes or featured by the media.
Name
*

Date * +

NON-DISCRIMINATION STATEMENT:

The Sioux City Community School District offers career and technical programs in the following areas: Business & Marketing, Family & Consumer Science, Health Science, and Industrial Arts, Technology, & PLTW.

The Sioux City Community School District is an equal opportunity/affirmative action employer and does not discriminate on the basis of race, creed, color, sex, sexual orientation, gender identity, genetic information (for employment), national origin, religion, age (for employment), disability, socioeconomic status (for programs), marital status (for programs), or veteran status (for employment) in its educational programs and its employment practices. The District is required by Title IX and 34 CFR Part 106 not to discriminate on the basis of sex in its programs, activities, or employment.

Inquiries or grievances under Section 504 and Title II of the Americans with Disabilities Act may be directed to Dr. Dora Jung, Director of Student Services & Equity Education/Title IX Coordinator at 627 4th Street, Sioux City, IA 51101, (712) 279-6075, jungd@live.siouxcityschools.com. Inquiries about the application of Title IX and its regulations to the District may be referred to the Title IX Coordinator, the Assistant Secretary of the U.S. Department of Education, or both. Please see District Board policies 103 and 504.4 for additional information on available grievance procedures.