Special Media Release Form

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This is a special form to collect parental permission for your student to be photographed, interviewed, or video-recorded as part of WYSO rehearsals, performances, and special activities pertaining to the WYSO/MSO Side-by-Side Concert the week of May 14 – 20, 2023.

MSO team members, WYSO team members, and perhaps the press will be taking professional photos and video, and recording interviews with some students. This may take place at the May 14 rehearsal, May 19 dress rehearsal, and May 20 concert. Imaging and recording will be professionally executed, and will be used to promote and increase public awareness of this WYSO/MSO collaboration through newspapers, radio, TV, the web, social media, and other types of media. While the focus will be on the orchestra as a whole, some student musicians may be highlighted or featured.

Additionally, the photo and media assets may be used in grant applications, impact reports, and newsletters.

  • I, as the parent or guardian of the minor listed below, hereby give WYSO and its employees, representatives and authorized partners and media organizations permission to print, photograph and record my child for use in audio, video, film, or any other electronic, digital and printed media and including in social media stories. 
  • This is with the understanding that neither WYSO nor its representatives will reproduce said photograph, interview or likeness for any commercial value or receive monetary gain for use of any reproduction/broadcast of said photograph or likeness. 
  • I am also fully aware that I will not receive monetary compensation for my child’s participation. 
  • I further release and relieve WYSO, its Board of Directors, employees, and other representatives from any liabilities, known or unknown, arising out of the use of this material. 
  • I certify that I have read the Media Consent and Release Liability statement and fully understand its terms and conditions. 

I give my consent to WYSO by filling out the form below and pushing the SUBMIT button.

Permission for these activities is required by Saturday, May 13, 2023.


Student Name*
Parent Name Name*
This submission form is to give permission for the student named above to participate in special activities, interviews, rehearsals, and performances that may be associated with the WYSO/Madison Symphony Orchestra Side-by-Side Concert the week of May 14-20, 2023. 2. By submitting this form, the student and student's parents acknowledge that the student may be video-taped, photographed, interviewed or featured on WYSO and MSO websites, newsletters, and social media, as well as on professional television, internet, and print newspapers and magazines.The student and student's parents give permission to WYSO and the Madison Symphony Orchestra to advertise the upcoming Side-by-Side concert by a variety of means including print, social media, or online/emails and to use the student's name and photographic likeness for this purpose. The student and student's parents also give permission for a video-recording of rehearsals and the final performance to be presented to a public audience via video-recorded means.
This field is for validation purposes and should be left unchanged.