ShoreLake Arts · Media Release Form

Student Information

Name

*

First Name

Last Name

Student's Age

Media Consent & Liability Release

ShoreLake Arts youth participants may be highlighted in efforts to promote ShoreLake Arts’ programs and activities. For example, participants may be featured in fundraising and promotional brochures and emails, ShoreLake Arts’ website, and other types of media.

As the parent or guardian of the student named above, do you give ShoreLake Arts and its employees, representatives, and authorized persons permission to photograph or record your child for use in electronic, digital, and printed media?

This is with the understanding that neither ShoreLake Arts nor its representatives will reproduce said photographs or likenesses for any commercial value. Parents/guardians will also not receive monetary compensation for their child’s participation.
You further release and relieve ShoreLake Arts, its Executive Board, Board of Directors, employees, and other representatives from any liabilities, known or unknown, arising out of the use of this material.

Please check one of the boxes below to indicate your preference

*

Yes, my child may be photographed

No, my child may not be photographed

By marking your name below, you certify that you have read the Media Consent and Liability Release statement above and fully understand its terms and conditions.

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First Name

Last Name

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