Media Release - Rosenberg Piano Lessons
MEDIA CONSENT & RELEASE

1. Grant of Rights.  I grant Rosenberg Piano Lessons (“Studio”) the unlimited, perpetual,
world‑wide right to record, reproduce, edit, publish, and distribute my (or my child’s)
image, voice, and likeness in any medium—including but not limited to Google Maps,
YouTube, Instagram, the studio website, printed materials, and any future platform.

2. No Compensation.  I understand no payment is due now or in the future.

3. Revocation.  I may revoke this consent at any time by written notice.  Revocation
applies prospectively only; media already created or published while this Release was in
force may remain in use indefinitely.

4. Waiver & Hold‑Harmless.  I waive all claims and release the Studio, its owners,
employees, and agents from any liability arising from lawful use of the media.

5. Governing Law.  This agreement is governed by the laws of the State of Texas.

You will receive an emailed copy of your signed release. Please retain it for your records.

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Email *
Student Name (first & last) *
Student Date of Birth *
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Student #2 Name (first & last) (if applicable)
Student #2 Date of Birth (if applicable)
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YYYY

I have read and agree to the Media Consent & Release above.

 *

By typing my name below, I am identifying myself as the parent or guardian of the student listed in this form, or I am representing myself as an adult student.

I consent to receive and sign this agreement electronically under the Texas UETA and the federal E‑SIGN Act. 

By typing my full legal name below and clicking Submit, I agree this constitutes my electronic signature on the Media Consent & Release.

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