Girls Inc. Teen Mentorship Program

I am the legal parent/guardian of (child's name)      ("My Child"). I hereby give unrestricted permission for My Child to be photographed, videotaped, digitally recorded, audio taped, and/or interviewed by Girls Inc. of Greater Santa Barbara ("GIGSB") or its representatives. I understand and agree that the photographs and/or video containing the image, likeness and/or voice of My Child, in whole or in part, may be used in the production of instructional and/or promotional materials produced by or on behalf of GIGSB, and may be shared with third parties, and that such materials may be distributed or broadcast to the public and displayed publicly. I also consent to the use of my child’s name, likeness or photograph, voice, or creative works on the internet or on other electronic/digital media or print media.

I hereby grant GIGSB, and its agents the absolute right and permission to use My Child's image/likeness/voice and/or photographic portraits, pictures, digital images, stories, quotes, audio, or video of My Child, or reproductions thereof or otherwise for any lawful purpose, whatsoever, including but not limited to use in any GIGSB promotion through publication, website, social media, video, interview, event and/or advertising. I hereby waive any right that I may have to inspect and/or approve the finished project or the copy that may be used in connection therewith, wherein My Child's likeness appears, or the use to which it may be applied.

I also understand that my permission to use the photographs, likeness, audio or video is for an unlimited duration. I also agree that no money or other consideration, including expense reimbursement, will be due to me or My Child, or our heirs, at any time because of My Child’s participation in any of the above or the use of My Child’s name, likeness, photograph, voice or creative work. 

As My Child’s parent or legal guardian, I agree to release and hold harmless GIGSB, its members, directors, agents, officers, contractors, volunteers and employees from and against any and all claims, demands, actions, complaints, suits or other forms of liability that arise out of or by reason of the use of My Child’s name, photograph, or likeness, voice, or creative work on television, radio, motion pictures, social media, internet, or any other electronic/digital media or print media. 

I understand that I will need to notify GIGSB in writing if any changes to my situation occur that will impact this media release. I understand that any changes in consent will apply from the date of receipt of that written notification moving forward and cannot be applied retroactively to previously created photographs, stories, quotes and the like, and/or any promotional materials. 

CONSENT: I hereby certify that I am the legal parent(s) or guardian(s) of the above named child and do hereby give my consent without reservation to the foregoing on behalf of My Child.

NON-CONSENT: I hereby certify that I am the legal parent(s) or guardian(s) of the above named child and do not hereby give my consent without reservation to the foregoing on behalf of My Child.

I am at least 18 years of age and am fully competent to sign this release.
Signature   

Assumption of Full Responsibility for all Risks of Bodily Injury, Death, or Damages: 

As a parent or legal guardian of      (your child's name), I hereby authorize and consent to their participation in the programs offered by Girls Inc. of Greater Santa Barbara ("GIGSB"). I understand that participation in activities at GIGSB, including but not limited to its after-school programs, remote and virtual programming, classes, field trips, sporting events, surfing, cooking, and other athletic events and activities may result in unavoidable injuries including, but not limited to, muscle or other soft tissue strains, sprains and tears, broken bones, and severe injuries such as paralysis or even death, and I voluntarily assume the risk of injury associated with those events.   
   (initial)

Notification: In case of injury, illness, or any situation that could require medical attention during or by reason of a GIGSB program or excursion, it is understood that a conscientious effort will be made to notify the child’s parent or guardian before medical attention or other necessary action is taken. If a parent or guardian cannot be located in a timely manner, I understand that the expense of this service will be accepted by the child’s parent or guardian on record. In the event that such care or medical treatment is deemed by GIGSB to be necessary, I agree to release GIGSB from any liability in connection with such care or medical treatment.       (initial)

Waiver of Liability: In consideration for allowing my child to participate in activities offered by GIGSB. I, my heirs and assigns, next of kin, and all others acting on my and my child’s behalf agree to waive any and all rights, claims, damages, actions, causes of action or suits of any kind or nature whatsoever which I or my child has or may hereafter have against GIGSB or any agent, employee, representative or other acting on their behalf and to indemnify, defend and hold harmless GIGSB or any agent, representative or other acting on their behalf for any injuries suffered as a result of engaging in those activities offered by GIGSB. I hereby release GIGSB and any agent, employee, representative or other acting on their behalf from liability for ordinary negligent conduct that may occur in the future.

   (initial)

Should any part or parts of this agreement be held null and void, the balance of the agreement shall remain valid and maintain its full force and effect. This acknowledgement of risk and WAIVER OF LIABILITY has been read by me and understood completely and signed voluntarily. I am 18 years of age or older.          (initial)

Parent/Guardian full name      First name  Last name   

Parent/Guardian signature   Signature   

1. I give my informed consent and permission for my child to participate in the Girls Inc. Mentorship Program and its related activities
2. I agree to have my child complete an individual Closure Form, if at any reason my child chooses to discontinue their participation in the Girls Inc. Mentorship Program.

ACKNOWLEDGEMENT

I, as the parent, guardian or designated representative of (child’s name)   have received and read information contained in the Admission Agreement, provided by Girls Inc. of Greater Santa Barbara, and agree to abide by the stated policies.