sINgSPIRE Virtual Choir
- Final Project Media Release -

Participant Name *

First Name

Last Name

Parent/ Gaurdian Name (if under 18)

First Name

Last Name

I, the undersigned, do hereby grant or deny permission to Breathe Bravely to use the image and/or recording of the above named participant, for creative, promotional, informative (social media), and educational purposes. I acknowledge that I own the rights to any photo or video shared with Breathe Bravely for use in Virtual Choir video production, and media/promotional releases, and I give my permission for Breathe Bravely to use these photos in a public manner as respectfully seen fit. If I submit professional photos, those rights have been released to me by the photographer. *

Deny

Grant

I, the undersigned, grant or deny permission to Breathe Bravely to share my name and email address with other members of the Virtual Choir. (Not for public consumption.) *

A roster will be shared amongst members of the virtual choir. This will include name and email address.

Grant

Deny

Today's Date *

MM

DD

YYYY