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Directory Information / Media Publishing Permission

The following is a sample list of items that could be potentially used for directory Information or Media Publishing.

*Directory Information may include: The Students Name; Address; Telephone Listing; e-mail Address; Photographs; Date and Place of Birth; Major Field of Study; Participation in Officially Recognized Activities and Sports; Weight and Height of Members of Athletic Teams; Dates of Attendance; Degrees and Awards Received; and The Most Recent Previous Educational Agency or Institution Attended By the Student.

South Haven Schools places pictures and articles of our students and their activities in the school media such as our newsletter, yearbook, website, and any other school-related media. We fully intend to take appropriate precautions in not revealing personal information about the student. Feel free to contact the school office with any questions.

Student 1 First Name*

Answer Required

Student 1 Last Name*

Answer Required

Grade (1)*

Answer Required

Student 2 First Name

Answer Required

Student 2 Last Name

Answer Required

Grade (2)

Answer Required

Student 3 First Name

Answer Required

Student 3 Last Name

Answer Required

Grade (3)

Answer Required

Student 4 First Name

Answer Required

Student 4 Last Name

Answer Required

Grade (4)

Answer Required

I, parent or guardian of the student(s) listed, give permission for my above listed child(ren) to have his/her picture used in South Haven School media as listed below:

Yearbook*

Answer Required

Yes

Newsletter*

Answer Required

Yes

Website*

Answer Required

Yes

Social Media*

Answer Required

Yes

For all uses that you approved above, check this box if you do NOT want your child's name listed with their picture:

Answer Required

Do not include my child's name

Signature*

Signature Required

Confirmation Email

Confirmation Email *

Email Required