Photo/Media Consent & Release Form

Dana Harris Saturday, Apr 04 2020 6:46PM

Lesson 1. Explore Your Community VIP Discovery Workshop Photo/Media Consent & Release Form

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Are You Ready To Play?
PHOTO/MEDIA CONSENT & RELEASE

We need your permission to create digital media content that includes you!
Under the age of 13? Click here
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Photo Consent & Release Form

Without expectation of compensation or other remuneration, now or in the future, I hereby give my consent to The NEXT Steps Youth Entrepreneur Program, its affiliates and agents, to use my image and likeness and/or any interview statements from me in its publications, advertising or other media activities (including the Internet).
This consent includes, but is not limited to:
1. (a) Permission to interview, film, photograph, tape, or otherwise make a video reproduction of me and/or record my voice;
2. (b) Permission to use my name; and
3. (c) Permission to use quotes from the interview(s) (or excerpts of such quotes), the film, photograph(s), tape(s) or reproduction(s) of me, and/or recording of my voice, in part or in whole, in its publications, in newspapers, magazines and other print media, on television, radio and electronic media (including the Internet), in theatrical media and/or in mailings for educational and awareness.
This consent is given in perpetuity, and does not require prior approval by me.
The below signed parent or legal guardian of the above-named minor child hereby consents to and gives permission to the above on behalf of such minor child.
Name of Participant
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date
MM slash DD slash YYYY
Electronic Signature
If 18 years or older. Parental consent required if participant is under the age of 18.
Parent/Legal Guardian
The below signed parent or legal guardian of the above-named minor child hereby consents to and gives permission to the above on behalf of such minor child.
Parent/Legal Guardian Name
First Last
Date
MM slash DD slash YYYY
Parent/Legal Guardian Electronic Signature

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Lesson 1. Explore Your Community

Quizzes

Photo/Media Consent & Release Form

Dana Harris Saturday, Apr 04 2020 6:46PM

Photo Consent & Release Form

Parent/Legal Guardian

CREATE!