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Media Objection Notice

The Sioux City Community School District strives to promote the many positives occurring daily in our classrooms. Media coverage of public events in which students of the Sioux City Community School District are participants is welcomed and encouraged. Pictures and video may also be captured to use for marketing purposes.   Each student/parent or guardian will be given an opportunity to opt out of such exposure. This form must be completed by September 15, 2017. 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.
Student Information
 First NameLast Name
Student 1  
Student 2  
Student 3  
Student 4  
Student School and Grade
 SchoolGrade
 BryantClarkEast HighEast MiddleHuntIrvingIrving PreschoolLeedsLibertyLoess HillsMorningsideNodlandNorth HighNorth MiddlePerry CreekRiversideSpalding ParkSunnysideUnityWest HighWest MiddlePKTKK123456789101112
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 District for marketing purposes or featured by the media. Name *
 
Date *
 
Nondiscrimination StatementThe Sioux City Community School District is an equal opportunity/affirmative action employer. It is an unfair or discriminatory practice for any educational institution to discriminate on the basis of race, creed, color, sex, sexual orientation, gender identity, national origin, religion, age (for employment), disability, socioeconomic status (for programs), marital status (for programs), or veteran status in its educational programs and its employment practices.  Inquiries or grievances may be directed to Jen Gomez, Director of Student Services & Equity Education at 627 4th Street, Sioux City, IA 51101, (712) 279-6075, gomezj2@live.siouxcityschools.com.