Media Release Form

Please check all the statements that apply: *

My child(ren) may be photographed in the music studio and/or at performances.

Christy Tallamy may use photographs taken during lessons, activities and/or performances on the PRIVATE website.

Christy Tallamy may use my child(ren)s pictures in a public setting such as an open webpage or public relations materials. (PUBLIC images will not be accompanied by personal information.)

MY CHILDREN MAY NOT BE PHOTOGRAPHED. THEIR IMAGES MAY NOT BE USED IN EITHER A PUBLIC OR PRIVATE MEDIA.

When using my child's photograph, you may include personal information such as (but not limited to) their name and school grade.

Yes

No

Please check all the statements that apply: *

Please do not use my contact information on the Little Ears website or in any printed material.

My contact information may be used in the MEMBER ONLY areas of the website.