Student Media Release - Wilson Creek School District

School Year 2016-2017
Dear Parents/Guardians
With the age of information and the expanded use of technology within our district, we find that there are more
opportunities to share student successes than before.
However, in this age of confidentiality and predators, our wish is to maintain a comfortable level of security for you
and your student. To this end, a media release form has been deemed necessary. This form is to insure the district
understands the level of media exposure of your student, you, as parents, are comfortable.
Below are options of media release. Check all that you are comfortable allowing for your student. If you have ANY
questions about these levels, PLEASE call Ms. Floetke.
I will allow my student’s picture in the district newsletter.
I will allow my student’s picture in the school annual.
I will allow my student’s picture in the area newspapers.
I will allow my student’s picture on the district website.
I will allow my student’s picture in GEAR UP activity publicity/publications.
7-12 GRADE ONLY: I will allow my student’s picture in the Community Calendar.
OR
I am not comfortable with my student’s picture released for district newsletter,
school annual, area newspapers, GEAR UP activities, or district websites.
Student Name(s) _______________________________________________________________
Parent’s Signature ____________________________________________________________
Please check the level(s) of media release you will be comfortable with this next year. If at any time these change,
PLEASE notify the district office or Ms. Floetke to change your release options.
Thank you for your cooperation.
Sincerely
Miss Floetke
Jackie Floetke
Technology Coordinator
The Wilson Creek School District does not discriminate in any programs or activities on the basis of sex, race, creed, religion, color, national origin, age, veteran or military status,
sexual orientation, gender expression or identity, disability, or the use of a trained dog guide or service animal and provides equal access to the Boy Scouts and other designated youth
groups. The Civil Rights Compliance Coordinator is available to handle questions and complaints of alleged discrimination. If you have questions and/or concerns please call Sally
Nelson (Civil Rights Compliance Coordinator) snelson@wilsoncreek.org or Amy Hickok (504/ADA Coordinator) ahickok@wilsoncreek.org or Kirk Freeman (Title IX)
kfreeman@wilsoncreek.org at Wilson Creek School District PO Box 46, Wilson Creek, WA 98860, phone 509-345-2541.
El Distrito Escolar de Wilson Creek no discrimina en sus programas o actividades por motivos de sexo, raza, credo, religión, color, origen nacional, edad, condición de veterano de
guerra o grado militar, orientación sexual, expresión de género o identidad, discapacidad o uso de perro guía entrenado o animal de servicio, y ofrece igualdad de acceso a los Boy
Scouts y a otros grupos de jóvenes especificados. El empleado mencionado a continuación ha sido designado para atender consultas y quejas de supuesta discriminación: Sally Nelson,
La directora, snelson@wilsoncreek.org o Amy Hickok ahickok@wilsoncreek.org o Kirk Freeman kfreeman@wilsoncreek.org Wilson Creek School District PO Box 46, Wilson Creek,
WA 98860, telephono 509-345-2541.