sINgSPIRE Virtual Choir
- Media Release Form-


Participant Name *
Participant Name
Parent/ Gaurdian Name (if under 18)
Parent/ Gaurdian Name (if under 18)
Media Release
I, the undersigned, do hereby grant or deny permission to Breathe Bravely to use the image and/or recording of the above named participant, for promotional, informative (social media), and educational purposes. *
Educational Usage: Images and/or recordings used in the setting of Breathe Bravely and educational materials. One example of this is the use of images and/or recordings participating in the sINgSPIRE Virtual Choir - showing its impact on CF for educational purposes during CF Family Days, conferences, or public education. Social Media Usage: Video compilations, images, and/or recordings of sINgSPIRE Virtual Choir used to share the mission, impact, and vision of sINgSPIRE via the Breathe Bravely Facebook page, Instagram account, and youtube account. Promotional Materials: Images and/or recordings used for promotional purposes such as printed materials, brochures, newsletters, and digital image design as used on the Breathe Bravely website. An example of use would be informative informational brochures for CF Care Centers to share with interested patients. (The last name of the student is never used in any sharing of images and/or video. )
Roster Information
I, the undersigned, grant or deny permission to Breathe Bravely to share my name and email address with other members of the Virtual Choir. *
A roster will be shared amongst member of the virtual choir. This will include name and email address.
Today's Date *
Today's Date
By typing your name in the box below, you acknowledge that you have read and filled out the above release to the best of your known ability.