SCVYO IMAGE RELEASE FORM. I authorize the Santa Clarita Valley Youth Orchestra Foundation, or anyone authorized by the SCVYO, to produce and use any and all images, video, still pictures, drawings, or the like, as well as content of written documents. These images and/or written documents are the property of the owner stated on this form, and shall remain that way.

PHOTO/DOCUMENT OWNER: SANTA CLARITA VALLEY YOUTH ORCHESTRA FOUNDATION

Student's Name *

Student's Name

First Name

Last Name

Name of Parent(s) or Guardian

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian Email

Parent/Guardian Phone

(###)

###

####

The student is a child under 18 years of age

Yes

Student's Date of Birth

YYYY

I consent to this image release as the legal parent/guardian of the above-referenced minor.

YES

Today's Date

YYYY