Mayor's Office Participant Application
NewarkWorks One Stop Career Center
Image "Use" Authorization Form
If your child is 14-17 years of age please complete the below form:
I {nameOf}, (parent/guardian) of {firstName} {lastName}, (youth participant) understand that while my child participates in the City of Newark Youth One-Stop Career Center's Summer Youth Work Experience Program, The Newark One -Stop Career Center, and any affiliates of the Summer Youth Work Experience Program ("The City of Newark") may take photographs, video, audiotape and other image and sound-based media of program activities and its participants. The City of Newark may wish to use such photographs, video, audiotape and other image and sound-based media for educational, promotional, advertising and other purposes, without compensation or prior notice.
Therefore, I as a parent and/or guardian of {firstName} {lastName}, (youth participant) hereby freely and voluntarily consent to the use and publication of {firstName} {lastName}, (youth participant) name, participation, picture, and/or likeness by the City of Newark and/or its employees and/or agents for any and all purposes including, but not limited to, educational, promotional, advertising and trade, through any medium or format, including, but not limited to, videotape, audiotape, film, photograph, television, radio, digital, internet, theater, or exhibition, at any time from this date forward. I further waive any claims against the City of Newark and/or its employees and/or agents based upon or related to its use or publication of my likeness, voice, participation and/or picture.
I freely give this authorization without expectation of compensation.