Media Release Home – Forms – Media Release Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Participant Name *Parent/Guardian Name *Required if the participant is under 18. Permission to Use Media *I grant permission to Period Zero to photograph, video record, and/or capture audio of the participant during program activities, including Teen Networking Nights and related events.Use of Media *I understand these materials may be used by Period Zero for program promotion, outreach, social media, website content, marketing materials, grant applications, grant reporting, educational purposes, and training purposes.Name and Likeness Consent *I understand that the participant’s first name, image, voice, and/or likeness may be used in connection with these materials. No last names or personal identifying information will be shared without additional consent.No Compensation Agreement *I understand that participation is voluntary and that no compensation will be provided for the use of these materials.Release of Liability *I release and hold harmless Period Zero, its staff, volunteers, and partners from any claims related to the use of photos, videos, audio recordings, or other media as described above.Media Permission Selection *Yes, I grant permission for Period Zero to use media as described above.No, I do not grant permission for media use. Name Agreement Consent Parent/Guardian/Participant Electronic Signature * Clear Signature Participant Signature if 18 or older*Date *Submit
