#WEAREONE

MASS ELITEBasketball 

2018 Media Consent Form

Player Name ________________

Please initial and sign

I ____ DO give consent to Mass Elite Basketball, its coaches, and/or program administrators to release my child’s image, and/or likeness in photos on its website, social media, and/or in publications for marketing and/or publicizing Mass Elite Basketball.

I ____ DO give consent to Mass Elite Basketball, its coaches, and/or program administrators release video images on its website, to media outlets or third parties as part of publicizing and/or marketing Mass Elite Basketball to the general public or groups.

I ____ DO give consent to Mass Elite Basketball to display my child’s name in association with a his/her image, and/or likeness in photos or video images on its website, www.masseliteselect.com, to media outlets or third parties as a part of publicizing and/or marketing Mass Elite Basketball to the general public or groups.

Printed Parent/Guardian Name: ___________________________

Parent/Guardian Signature: ___________________________

Date: