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Cart
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Home
About Us
Our Organization
Our Story
Our Impact
Our Supporters
Cystic Fibrosis
Supportive Literature
Our Programs
The Voice Lesson Program
Enrollment Info & Form
Meet our Instructors
*sINgSPIRE Virtual Choir
SVC9: "There's a Mountaintop"
Events
Sing It for CF: A Marathon of Song
Backyard Bash at Levitt at the Falls
Cocktails for a Cause
Store
Donate
sINgSPIRE
- Media Release Form-
Session 13
Student Name
*
First Name
Last Name
Parent/ Gaurdian Name (if under 18)
First Name
Last Name
Email Address
*
Media Release
I, the undersigned, do hereby grant or deny permission to Breathe Bravely to use the image and/or recording of the above named student, for promotional, informative, and educational purposes for the sINgSPIRE program.
*
Deny
Grant
Grant Permission in the following ways:
*
Please check all that apply. See below for details.
Educational Usage *
Social Media Usage *
Promotional Materials *
Not Applicable
Educational Usage: Images and/or recordings used in the setting of Breathe Bravely and educational materials. One example of this is the use of images and/or recordings participating in sINgSPIRE program - showing its impact on CF for educational purposes during CF Family Days, conferences, or public education. Social Media Usage: Video compilations, images, and/or recordings of sINgSPIRE students used to share the mission, impact, and vision of sINgSPIRE via the Breathe Bravely Facebook page and Instagram account. Promotional Materials: Images and/or recordings used for promotional purposes such as printed materials, brochures, newsletters, and digital image design as used on the Breathe Bravely website. An example of use would be informative informational brochures for CF Care Centers to share with interested patients. (The last name or location of the student are never used in any sharing of images and/or video.)
Signature
Today's Date
*
MM
DD
YYYY
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.
Thank you!
