1600 W Douglas Ave Wichita, KS 67203

(316) 687-5880

Permission to Publish

TO: Parents/Guardians of Ballet Wichita dancers

FROM: Ballet Wichita

RE: Permission to publish

Permission to Publish:

Please check one of the statements below. By signing below, I give Ballet Wichita permission to photograph or interview me/for my child to be photographed or interviewed in/during the course of rehearsing and/or performing with Ballet Wichita and for those images to be appear on the Ballet Wichita website, company related publications and/or videotape done by the media or a representative of Ballet Wichita or designee of approved broadcast or publication in a radio, television, print or multi-media presentation used to report on Ballet Wichita programs, services, dancers and performances.

Please NOTE: Ballet Wichita cannot/does not control what is published in social media/online nor can we regulate any group photographs taken by the public at our performances.

I DO grant and give Ballet Wichita the right to produce, exhibit, publish or distribute such materials in which my child appears.

I DO NOT grant or give Ballet Wichita the right to produce, exhibit, publish or distribute such materials in which my child appears.

Signature

IF DANCER IS UNDER THE AGE OF 18:

Parent Signature