Summer Camps – Waiver 3 of 3

Please read and fill out the Photo and Video Release below:

The undersigned hereby consents to and authorizes the use by The Neighborhood Music School of the undersigned’s name, image, voice and/or likeness and hereby grants The Neighborhood Music School the right to publish, republish, adapt, exhibit, reproduce, edit, modify, make derivative works, distribute, display or otherwise use or re-use the undersigned’s name, image, voice and/or likeness, including video interviews, in connection with promotion of The Neighborhood Music School, LLC in all markets, media or technology now known or hereafter developed, including advertising, promoting and merchandising of those entities. The Neighborhood Music School, LLC may exercise any of these rights itself or through any successors, transferees, licensees, distributors or other parties.

I represent that I am a parent/guardian of the minor who has signed the above release and that in that capacity The Neighborhood Music School has my consent and authorization to use the name and/or likeness as described above.

Please fill out the form on the previous page