YAAS Submit Release Form – Sister Cities of Long Beach

PUBLICITY RELEASE AUTHORIZATION FORM

I am the parent/guardian of

Full Name of Child ( My Child) *

First

Last

I hereby authorize Sister Cities of Long Beach, Inc. (SCLB), their partners and agents to produce, create, publicize, and otherwise use photographic portraits, pictures, digital images or videotapes and recordings of my child or produced by my child for the explicit purpose of marketing activities related to the 2022 YAAS Program.

I understand that all images provided, created, or produced become the sole property of SCLB and that SCLB and its partners and agents may use these images at its discretion at any time now and in the future.

Pursuant to this authorization, I hereby release SCLB and its partners and agents from any and all liability arising from or in connection with the use, creation, publication and dissemination of any images provided to or produced by SCLB.

CONSENT *

We/I hereby certify that We/I are/am the parents(s) or guardian(s) of the above-named child and do hereby give our/my consent without reservation to the foregoing on behalf of My Child.

Parent/Guardian Name *

First

Last

Parent/Guardian Email *

Parent/Guardian Phone

Parent/Guardian Signature *