Parent Opt Out for Media Materials Form

Note: This is a permanent restriction unless a written request is made to rescind this action. This request can take up to 7 days to process. You will receive an email once the request has been completed.

Parent Name(Required)

First Last

Parent Email(Required)

Parent Phone Number(Required)

Student Name(Required)

First Last

Student Email(Required)

Student ID Number(Required)

Student School Currently Attends(Required)

I would like to restrict my student from the following:(Required)

All library media materials in Dearborn Public Schools

A specific library media material item

All books on the “Book Challenge” List

SORA Online Library

View Book Challenge List

Title of Material to be removed from access(Required)

*MUST contain a specific book title you wish to restrict access to.

Author's name(Required)

*MUST contain an Author’s name to be sure the proper book is restricted.

I certify that I have legal authority to make this decision for the student listed.

Yes

(This is to ensure you are the legal guardian or parent with custody.)