Consent for Videotaping, Photographing, and Recording You may be videotaped/photographed/recorded as part of the Golden Apple

Scholar Program for The Golden Apple Foundation for instructional, educational, public relations, or informational productions. This consent is requested for images/recordings intended to be made available to the general public. Here are the administrative procedures as follows: For Website, blogs, newsletters, brochures, and presentations to educational professionals You may be shown in group photos and only identified as a group. You may be shown in individual photos without identification by full name. Your work and products may be displayed without identifying the author by full name. For local newspaper coverage and local cable community access channels You may be shown in group photos and only identified as a group. Your work and products may be displayed with identifying the author.

Any questions, please contact me beatechie@gmail.com

Please return to Carol Broos
Please check and sign, or put email on the bottom. ______I grant consent for the use of videotaped/photographed/recorded media made of my children in the music department, under the conditions stated. _______I do not grant consent for the use of videotaped/photographed/recorded media made of my children in the music department, under the conditions stated. ________________________/______________________/_______________________ Print Your Name Date Your Signature

CBroos 7/2009

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