Photo Opt-Out


Oct 06, 2022 10:00 AM



PHOTO OPT OUT RELEASE FORM
I do not authorize 3’NMotion Dance studio of Saint Augustine aka Dance Studio of Saint Augustine LLC, its employees or volunteers, to record photographs or other images or likenesses of my dancer in the form of videotape, audiotape, film or digital stills, or any other medium. I do not authorize 3’NMotion Dance Studio to use, reproduce, modify, distribute, or publicly exhibit such recordings, in whole or in part, for any purpose.
Further, I do not consent to the use of my child’s name or voice in connection with any such recording.
☐I understand it is my responsibility to remove my child from areas being videotaped or photographed and to notify the photographer of my opt out status.
☐I hereby confirm that I am legally of full age (18) and have every right to contract in my own name as stated above.
☐I hereby confirm that I am the parent or guardian of the child been register. I further affirm that I have read the above “Photo Opt Out of Release,” and am familiar with its contents.
Date: ______________________________________________________________
Name: _____________________________________________________________
Address: ____________________________________________________________
Phone/Email: ________________________________________________________
Signature: ___________________________________________________________
Name of parent/guardian (if child is under 18): _________________________________
Signature of parent/guardian (if child is under 18):_______________________________
Please return the completed form to the Service Desk