I hereby release the information provided in this application to the Clinton County Farm Bureau for their use in awarding the Community Impact Grant. I also understand that the Clinton County Farm Bureau will retain this application indefinitely and will deem the information contained in this document as confidential to all people, except those authorized to evaluate this application for purposes of awarding the grant. On behalf of my heirs, assigns, and legal representatives, I hereby release and forever discharge the Clinton County Farm Bureau, any and all of their affiliated organizations, parents, subsidiaries, successors, assigns, directors, officers, agents, managers, members, and employees from any and all claims, demands, actions or causes of action, including injury, death or damage to property, which may occur during or as a result of completion of this community project. I assume all risks associated in completion of the project listed in this application. Further, I hereby consent to the use of my name, photographs, motion pictures or other reproduction of myself by the Clinton County Farm Bureau or its agents solely on behalf of the Clinton County Farm Bureau, or successors or assigns of the Clinton County Farm Bureau for any purpose whatsoever, including any advertising, trade, commercial, or art purpose and use in any publication or other advertising media, including the internet, without limitation or reservation.