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Photo Release Form -Text Only-


Brian Dolan


Shawntel McCammon


Dear Parent/Guardian,

On occasion, representatives from and/or employees of the Dixon Unified School District wish to photograph, videotape, and/or interview students in connection with school programs, projects, or events such as:

  • School and/or district websites

  • School Newsletters (print and online)

  • Newspapers, publications

  • Televised board meetings or other televised events

The images may show a group of students or an individual student.

In order to release photographs, video footage, and/or comments, and/or to post on district school websites, we need written permission.

I hereby AGREE ___, DO NOT AGREE ____ to allow my child,

to be photographed, videotaped and/or voice recorded and for

his/her name, image likeness and voice to be used in DUSD-approved photographs, videos, publications, internet, news and social media and web pages for educational or public relations purposes. By agreeing, I authorize the use and reproduction by the District or anyone authorized by the District of any and all photographs or videotapes taken of my child, without compensation to me/my child. All of these photographs/video recordings shall be the property solely and

completely, of the Dixon Unified School District. I waive any right to inspect or approve the finished photographs/videotapes, and the sound track, script or printed matter that may be used in conjunction with them.

Please understand that failure to return this release form within ten (10) school days from the date of distribution will constitute approval of the above requests.

Student's School: Date:

Parent/Guardian Name (print):

Signature of Parent/Guardian:

This request will remain valid until revoked in writing.