Skip to main content

Loading...

Editing previous response:

Please fix the highlighted areas below before submitting.

Photograph and/or Name Omission Form

PLEASE OMIT

I understand that the Centralia School District, my child's school, or my child's classroom teacher may use my child's photograph and/or name for use in school and/or district websites unless this form is filled out completely and submitted to the District Office. I submit this completed form as my request to omit (withhold) the following from any and all school or district websites. Please omit the following from any school or district websites.
Answer required for "I understand that the Centralia School District, my child's school, or my child's classroom teacher may use my child's photograph and/or name for use in school and/or district websites unless this form is filled out completely and submitted to the District Office. I submit this completed form as my request to omit (withhold) the following from any and all school or district websites. Please omit the following from any school or district websites. "
Parent or Guardian Signature*
Signature Required

Sign this form

By pressing “Sign Form,” you are agreeing to signing this form electronically.
Signature *
Type to sign
Draw your signature
Date:
Confirmation Email