Student Media Release Form – North Carolina Music Educators Association

Parental release form for photos and/or videos of students from the NCMEA Conference.

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*
Date Format: MM slash DD slash YYYY
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