Media Usage Consent Form

Thank you for participating in our events and activities at Virtus Music!

We love showcasing the talents and achievements of our students and community. With your permission, we would like to share photos, videos, and recordings of you or your child on our social media platforms, websites, and other promotional materials.

Please fill out the form below to give your consent for media usage.

Name of the Student

First Name

Last Name

Student Type

Youth

Adult

Media Usage Agreement

I grant Virtus Music permission to use my/my child's image, video, and audio recordings for promotional purposes, including but not limited to print, video, digital, and internet media (e.g., social media, websites, marketing materials).

I understand that these materials may be edited, copied, exhibited, or published by Virtus Music for educational and promotional purposes.

I acknowledge that this consent is voluntary and that there will be no compensation for the use of my/my child's image, video, or recordings.

Preferred Name Usage

Use full name

Use first name and last name initial only

Prefer to remain anonymous

Signature

By typing your full name below, you are providing an electronic signature to confirm your consent for media usage as outlined in this form.

Date

YYYY

Revocation Clause

I understand that I can revoke this consent at any time by providing written notice to Virtus Music.