Media release in-person

U4SC Media Consent Form 2023

Student Name *

Parent/Guardian Name *

Parent/Guardian Email *

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.

Images, videos, and/or audio recordings of my child may be shared with program participants and family members

Yes

Materials produced by my child, including written work and my child’s first name, may be published on U4SC websites

Yes

Images, videos, and/or audio recordings of my child may be used for educational and promotional purposes (e.g. social media)

Yes

Parent/Guardian Signature *

Clear

Date *