Media Release

Parent Full Name:

Parent Email Address:

My signature serves as authorization for The Carolina Academy to:
● collect samples of my child’s work
● take photographs of
● make audio and/or visual recordings of my child and/or me throughout our involvement with school, athletics, clubs, etc., with The Carolina Academy.

I understand that The Carolina Academy may present, publish and/or
edit for publication any of the above materials to be used for educational or informational
activities.

No commercial use of my image, voice or work will be allowed without further permission
from me.

Student Name:

Grade:

Parent Signature:


Agreement Date: