2026-27 Media Waiver Opt-Out Form

2026-27 Media Waiver Opt-Out Form

Please complete this form only if you wish to opt out. One form per student.
Information collected in this form will be used solely for the management of media permissions.

This opt-out applies to Somersfield Academy media and publications for the 2026–27 academic year and must be resubmitted annually.

If this form is not submitted, Somersfield Academy will assume consent is granted for standard educational and promotional use.
Student's Full Name

First NameLast Name
Student's Class
I do not consent for my child's image or voice to be used for Somersfield Academy*:
*We cannot guarentee that a child will not appear in Live coverage of school events that are filmed internally or externally by media organisations.

Somersfield Academy will make reasonable efforts to notify external media outlets and partner organisations of Media Waivers; however, we do not have editorial control over, nor can it guarantee compliance by, third-party publications.
You selected “Other” — we’d appreciate it if you could briefly explain in the text box below.
Please upload a photo of your child (this will only be used for reference)

Cancelof
Parent Name

First NameLast Name
Parent Email
example@example.com
Comments
A confirmation email will be sent upon submission.
We work hard to ensure names are spelled correctly, permissions are honoured, and everyone is represented with care and respect. But mistakes can happen.

If you notice anything that needs correcting, please let us know.

You can reach us at marketing@somersfield.com, 535-8700, or 239-3367. We’ll do our best to make it right.
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