Media Release

Use Definitions

General Notice

Use definitions agreement

I have read and understood the "use definitions" on the preceding pages.

Students Explanation

Students Enrolled

Student 1 First Name

Student 1 Last Name

Do you need to add another child student?

Student 2 First Name

Student 2 Last Name

Student 3 First Name

Student 3 Last Name

Student 4 First Name

Student 4 Last Name

Consent

PRIVATE: shared with "student(s)" and family

STUDIO COMMUNITY: shared with Ian Belloso and Piano Belloso Music community members (teachers, parents, and students), including members of the Simply Music organization.

GENERAL PUBLIC: shared publicly via print (newsletter, advertisements) and online (social media, website, blog) for educational and marketing purposes.

Signature and Release

E-signature First Name

E-signature Last Name