I certify that I am the parent/legal guardian of the minor child named above. I hereby grant permission to United 4 Social Change (U4SC) employees, contractors, licensees, volunteers, and affiliates to take photographs and audio/video recordings of my child, in connection with my child’s participation in U4SC programming. I consent to use of the aforementioned media, as well as work produced by my child, for educational, promotional, and other lawful purposes, in perpetuity, according to my selections below. I hereby waive all rights, if any, to inspect or approve materials for publication and receive compensation.

I acknowledge that I have read and understand this form prior to signing, and it shall be binding upon me, my heirs, assigns, and legal representatives.