The Fielder Studio of Music
Internet Use Permission Form
Effective September 21, 2009 , I will have a website for voice and piano lesson use. Beginning immediately, I would like to feature my students on the website under the heading “Featured Students”. On this page I will post student and parent approved performance videos, audio recordings as well as still pictures of students in performance, workshops and rehearsals for any music or performance related events they would like to share with family, friends and other students and parents in the studio.
I would also like to announce the achievements and accomplishments of my students (past and present) under the heading “Student Awards and Accomplishments”. This page will feature students who have entered competitions, (solo & ensemble, NATS, Federation, MMTA Student Achievement Testing, etc.), performed in school and community productions, (Musicals, Theater Productions, Talent Shows, Choral Concerts), attended music or theater workshops, received honors, awards or scholarships for music related activities, (Honors Choir, Community Chorus, Michigan Opera Theater, Blue Lake, Interlochen, Religious Music Performances and competitions, Band and Orchestra Awards, College Scholarships, etc.). This page will also feature past students who have moved on to study music at the college level, who have become music teachers themselves or are embarking on a music performance career.
I would like your permission to use your child’s likeness, in any of the ways listed above, of which you would approve. This form will be kept in my personal student files, maintained here in my studio, and will be reference before anything of your child’s appears on the website.
The URL is www.fieldermusicstudio.com. This website , most likely, will only be viewed by people in this area. It can be handy tool for you to refer your friends and relatives to in order for them to see a video or picture of your child’s performances and to be able to read about their accomplishments and to hear the latest music that they are working on. I have a video recorder, digital audio recorder and digital camera with which to record performances in the studio if it is decided that you and your child would like to share music that they have prepared in their lessons on the website. I also will welcome your pictures and videos of performances outside the studio. Please keep me informed about all of the music and theater related activites your child is in involved in and also any awards, honors or scholarships they have received. (Programs of performances , copies of awards, honors and scholarships for my studio files are greatly appreciated as well.) If you wish, I can provide you with a preview of the information and or performances pertaining to your child before it appears on the website.
Please check the areas below that I will have your permission to use your child’s information as noted on the website.
_______ First name only
_______ First name and Last initial only
_______ Full name
_______ Picture performing or in practice
_______Video recording
_______ Audio recording
_______Accomplishments
_______Please email me a preview of web information for my approval prior to posting (sound and video previews will require viewing in person at the lesson)
I hereby grant my permission to Jessica Fielder to use my child’s likeness in the above checked forms on the website www.fieldermusicstudio.com from this point on or until I expressly deny, in writing and hand delivered to Jessica Fielder, the use of my child’s information.
______I prefer my child’s likeness NOT be used in ANY form on the website.
____________________________________ __________________________________ ________________
Father’s Signature Father’s Printed Name Date
____________________________________ __________________________________ ________________
Mother’s Signature Mother’s Printed Name Date
____________________________________ __________________________________ ________________
Legal Guardian Signature Legal Guardian Printed Name Date
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