Please complete and return this form ONLY if you do NOT wish for Trefoil Academy to record your participation and appearance on any recorded medium for PROMOTIONAL PURPOSES.

This Photo Opt Out Release must accompany the appropriate documentation (i.e. Assumption of Risk/Waiver of Liability and Agreement to Trefoil Academy Policies) for your participation in any Trefoil Academy Program ("Program"). This Photo Opt Out Release is applicable and valid for up to 6 months from the date of signature for on-going Program.

I, the undersigned, do not wish Trefoil Academy to record my participation and appearance on any recorded medium including, but not limited to video, audio, photos (collectively, "recordings") for use in any promotional materials (including, but not limited to print, websites, blogs, internet).

I understand that Trefoil Academy CAN use all recorded mediums to record participation for internal purposes such as creating a year-end slideshow or allowing downloads of recorded material for Program participants.

I understand Trefoil Academy will make reasonable efforts to comply with my request. If I become aware of a recording with my likeness, I will notify the Trefoil Academy Camp Director contact for the Program. I understand that Trefoil Academy will then make reasonable efforts to remove my likeness from recordings. I hereby confirm that I am of legal age (18) and have every right to contract in my own name as stated above or am the guardian(s) of a dependent participating in a Trefoil Academy Program. I further affirm that I have read the above Photo Opt Out Release, and am familiar with its contents.