2965 Hwy 43, Kemptville +1-613 258-1931

Release Form for Media Recording

Please read and fill out the form below

I, the undersigned, do hereby grant or deny permission Madison Montessori Academy to use the image of my child, as marked by my selection(s) below.

Such use includes the display, distribution, publication, transmission, or otherwise use of photographs, images, and/or video taken of my child for use in materials that include, but may not be limited to, printed materials such as brochures and newsletters, videos, and digital images such as those on the Madison Montessori Academy Web site.