Volunteer Handbook Statement of Certification

I,   First Name   Last Name   , certify that I have received and reviewed the Living for Zachary Volunteer Handbook. I further understand that by signing this statement as required I am indicating that I have read the Volunteer Handbook and understand its contents, or have discussed questions I have with the Program Manager. I also realize that this statement will become a permanent part of my volunteer personnel file.

First Name      Last Name  
Signature   
Street Address   Address Line 2   City   State   Zip   
Date    

Persons under the age of 18 require the consent of a parent or guardian, as follows:
I certify that I am the parent or guardian of   First Name   Last Name   and do hereby give my consent to the aforementioned on behalf of this person.
Signature   
First Name   Last Name   
Date   

I hereby grant Living for Zachary, its affiliates, its clients, and employees (collectively, the “Released Parties”) permission to capture photographs or videos, use, reuse and publish my likeness in all media publications, videos and web sites.

I hereby irrevocably authorize the Released Parties to edit, alter, copy, exhibit, publish or distribute this media for any lawful purpose whatsoever including, without limitation, promotional and advertising uses. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I wave any right to payments, royalties or any compensation arising or related to the use of the media.

I understand that, although the Released Parties will endeavor to use my photograph, video or likeness in accordance with standards of good judgment, the Released Parties cannot warrant or guarantee that any further dissemination of my photograph(s), video(s) or likeness, reproduction, distribution, and display of the photographs in print or any and all other media, and any alteration, distortion or illusionary effect, whether intentional or otherwise, in connection with said use. I also understand that I may not withdraw my permission for the use of any photographs or other likeness at any time in the future.

I hereby release, hold harmless and forever discharge the Release Parties from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other person’s action on my behalf or on behalf of my estate have or may have by reason of this authorization.

I understand and agree that the captured images are the property of the Released Parties.


I am 18 years of age and competent to contract in my own name. I have read this release and fully understand the contents, meaning and impact of this release and freely consent to its contents.
Signature   Date   
First Name   Last Name   Date   


Persons under the age of 18 require the consent of a parent or guardian, as follows:
I hereby certify that I am the parent or guardian of   First Name   Last Name   and do hereby give my consent to the aforementioned on behalf of this person.
Parent/Guardian Signature   Date   
First Name   Last Name   Date