Publication Release Form

Student's Name*
First Last
I, hereby give and forever grant Proctors permission and consent for value received and without further consideration or compensation to the use (full or in part) of photos and all videotapes taken, recordings made of the child’s voice and/or written extraction, in whole or in part, of such recordings or musical performance for the purposes of illustration, broadcast, web cast or distribution in any manner By Proctors for the Collaborative School of the Arts or for any other purpose.

It is the intent of Proctors to use these photographs and videos in educational materials and future promotions of the theatre.

I further warrant to Proctors that I am the parent or legal guardian of the above stated child or above 18 and have every right to grant the permission outlined above:
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Electronic Signature By typing your name below and hitting Submit, you are agreeing to the above.
Student's Email*
Signature*
First Last
Date*
MM slash DD slash YYYY

Dear patrons: