Student Media Release Form – North Carolina Music Educators Association

NCMEA will take photographs during the conference for archival and publicity purposes. These images may be used on the website, conference recordings, newsletter and other NCMEA printed materials. By submitting a completed form you are granting NCMEA media permission of your child.

Student Name (First and Last)*

First Last

Parent/Guardian Name (First and Last)*

First Last

Date of Agreement*

Select Permission Status*

Yes, I give NCMEA permission to photograph and video my child
No , I do not give NCMEA permission to photograph and video my child

Parent/Guardian Electronic Signature (Full Name)*

Prefix First Middle Last Suffix

Students Media Release Form