SMI Photo/Video Opt Out Form

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SMI Photo/Video Opt Out Form

Photos and videos of campers are frequently taken by staff of the Summer Music Institute and other employees of Western Illinois University for use in programs, publications, web sites, social media and/or other marketing purposes. Parents (or students, ages 18 or older) must opt-out if they do not want their camper to be photographed for these purposes.

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* Indicates required question

Email *

Your email

I do not want my camper photographed/video taped or photographs/videos of published. *

Option 1

Required

Camper Name *

Your answer

Physical Description *

Your answer

Parent/Guardian Name *

Your answer

Date *

MM

/

DD

/

YYYY

Submit

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