KIDSTAGE Media Abstention Form

Please fill out one form per student, per session (fall, winter, spring, summer).

Media Usage: Village Theatre routinely uses student names and images to help promote Village Theatre Youth Education programs both in materials and events created by Village Theatre staff, as well as press releases, articles and stories generated by external media agencies.

Withholding Permission for Media Usage: By completing and submitting this form, you are withholding permission for Village Theatre to use the name, photograph, likeness, video, or voice recording of your student for broadcast or publication.

Term: This form will be in effect for the session indicated below.  A new form must be completed each session that media abstention is desired.