NSMTA Media Release Form

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Please complete this form to grant permission to the North Shore Music Teachers Association (NSMTA) to:

a) Use photographs, audio, and/or video recordings of your child participating in NSMTA activities
and/or
b) Publish your child’s name in recognition of an award or achievement in an NSMTA event.

Any media or recognition may be used solely to highlight student achievements and participation in NSMTA events, and may appear in publications including, but not limited to:

The NSMTA website: www.nsmta.org
Member newsletter: The SCORE
NSMTA public and/or Members-Only Facebook pages

Once signed and dated, this form shall remain in effect indefinitely. At any time, however, the parent/guardian signing this form may amend it by notifying NSMTA in writing of the requested change.
Contact: admin@nsmta.org.

Note: this form must be filled out separately for each participating child in your family.

Email *

Student Full Name *

NSMTA Teacher's Name (if applicable)

I hereby give media release consent for my child in accord with the above statement. *

Yes

I agree to allowing personal identifying information (e.g. child's name) to be shared.

Yes

Parent/Guardian Name *

Typing your name serves as your signature.

Parent/Guardian Email Address *

Date Signed: *

YYYY

A copy of your responses will be emailed to the address you provided.

Submit

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