sINgSPIRE - A Night of Song
Media Release

Name of Student

First Name

Last Name

Name of Parent/ Guardian (if under 18)

First Name

Last Name

Email Address

I ________ permission to Breathe Bravely to use images or video clips of myself or child for the educational and informative purposes of sINgSPIRE.

Grant

Deny

Signature

By typing your name in the box below, you acknowledge that you have read and filled out the above release to the best of your known ability.

Deny any permission to use my or my child’s image/recordings for any purpose.