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This form is required by FEMEA Virtual Honor Ensemble performers to allow their video submissions to be included in our Virtual Performance.

As parent/legal guardian of a Virtual Honor Ensemble participant, I hereby authorize FEMEA the right and permission to copyright and/or publish, reproduce or otherwise use this child’s name, voice, and likeness in video, audio-visual recordings and streaming. I acknowledge and understand this video performance may be used to promote the work of the Florida Elementary Music Educators Association, a 501c3 organization that supports elementary music education in Florida.

I understand that  images may be edited, copied, exhibited, published and/or distributed. I also understand this performance may be used in public/social media broadcast. There is no time limit on the validity of this release nor are there any geographic limitations on where these materials may be made available.

I hereby acknowledge and grant FEMEA and its employees, agents, licenses, successors, and third-party organizations all ownership rights and irrevocable permission to use, copyright, publish, and/or promote the recorded video and/or audio as part of a virtual performance of honored elementary performers from around the state of Florida.

I understand that my video submission is voluntary and that I may, at any time, discontinue my involvement before submitting the video. If I choose to discontinue participation, a video will not be submitted.

I understand that FEMEA can see no risk presently, and that I take full responsibility for my involvement in this project and the risks that it may entail (be they legal, physical, or mental) and release FEMEA from any claims, demands, losses, damages, suits, and liabilities of any kind whatsoever in connection with the foregoing.

I hereby certify that I am the parent/legal guardian of this child and am competent to contract in my own name insofar as the above is concerned. 

 

 

First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address
Email*
Confirm Email*
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School Information
Name of School
Name of Music Teacher
Grade Level
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Middle Name
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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