Media Release - Piano Belloso Music Studio

1

Private

In some cases, I may record media with the express purpose of only making that media available to the student and their family; in which case, the media will be stored on my own secure Google or Dropbox account, or within the student’s private online account(s) (Student Portal or Better Practice), and shared privately.

2

Studio Community

Another type of use could be the release of media recordings to the internal community of Piano Belloso Music Studio or the Simply Music organization. Some media can be selectively shared via email, private links, and private YouTube videos made accessible only to other teachers, parents, and and/or other Simply Music students for educational or evaluation purposes.

3

General Public

As a private music instructor, my first and best choice of promotion is word of mouth.

In today's world, that also means utilizing the internet and social media to show others my teaching style and simultaneously demonstrate results. Featuring current students in tutorials, posts, and social media content is the most effective means of doing this.

From time to time, I may request to take a picture, video, or audio recording during a lesson for such use. I may also take photos, record audio, and/or videos at events such as recitals and live streams, or have them professionally recorded by a third party. Both of the above examples would constitute a use of media that is PUBLICLY accessible for educational or marketing purposes.

Note: A minor’s last name will either be omitted, or only the first letter will be shown in conjunction with any video, digital images, or printed materials, even when made publicly accessible.

4

***In ALL of the above use case scenarios, I ALWAYS give notice to students and families at the time that any recordings are made. However, I still require an official release to be completed in advance and kept on file for legal purposes.***

5

I have read and understood the "use definitions" on the preceding pages.* This field is required.Private, Studio Community, and General Public

Yes, Continue

6

Student #1 Name* This field is required.

First Name

Last Name

7

Do you need to add another student?* This field is required.

YesNo

8

Student #2 Name* This field is required.

First Name

Last Name

9

Do you need to add another student?* This field is required.

YesNo

10

Student #3 Name* This field is required.

First Name

Last Name

11

Consent* This field is required.I, the undersigned, do hereby GRANT permission to Ian Belloso and Piano Belloso Music to use media recordings (photo, video, audio) of "students" (listed on preceding pages) and/or myself in ALL the following ways:

PRIVATE: shared only with "student(s)" and family

STUDIO COMMUNITY: shared with Ian Belloso and Piano Belloso Music Studio community members (teachers, parents, and students), including members of the Simply Music organization.

GENERAL PUBLIC: shared publicly via print (newsletter, advertisements) and online (social media, website, blog) for educational and marketing purposes.

12

I, the undersigned, hereby release Piano Belloso Music Studio, and any of its associated or affiliated companies, their directors, officers, agents, employees and customers, and appointed advertising agencies, their directors, officers, agents, and employees from all claims of every kind on account of such use(s) as described and permitted on the preceding pages.

13

E-Signature Name* This field is required.A parent or guardian must provide signature for anyone under the age of 18 years old.

First Name

Last Name

14

Date of Birth* This field is required.To confirm you are an adult, parent or guardian of legal age

Type or Select from Calendar

15

E-Signature EmailPlease provide your email address below

student@email.com

Confirm Email

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Signature* This field is required.You may need to rotate smaller mobile device to LANDSCAPE orientation.

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