Media Exemption Form

Purpose of This Form

This form is OPTIONAL. Please submit this form only if you DO NOT want your student's picture to be published in any way (Youth Instagram or Facebook group, First Cary website, etc.). Please note that First Cary will never post full names of minors, tag personal accounts of minors, or include any other easily identifiable information in its posts without express written permission from a parent/guardian. If you complete this form, your students may be asked to step out of some group photos at youth events.

First Name *

Last Name *

Parent's Name *

Parent's Phone *

Parent Email *

First Cary does NOT have my permission to publish my child's image. Unless signed below, I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.

Parent/Guardian Signature *

Tip: Typing your name serves as your signature to this waiver