Live The DREAM: Youth Excursion - Historical Immersion Participation Consent & Photo Release Form

Live The DREAM: Youth Excursion - Historical Immersion Participation Consent & Photo Release Form

I hear by grant permission for my child to attend the Live the Dream: Youth Excursion | Historical Immersion on June 27th-28th 2025. This event will be held at the UCF Rosen School of Hospitality/ Universal Terra Luna. Photos/videos to be taken by the Florida Civil Rights Museum, Inc. at this inaugural event for program development and marketing pourpses. By signing below, the undersigned parent or legal guardian hereby grants The Florida Civil Rights Museum, Inc. and its representatives the irrevocable right and permission to photograph, record, or otherwise capture the minor’s likeness in any media, and to use, reproduce, publish, display, and distribute such images or recordings for lawful promotional, educational, or informational purposes. Participants will not receive renumeration ( Payment ) for their participation or the future use of images ,media created from the event.
Participant Full Name

First NameLast Name
Parent/Guardian Full Name (if participant is a minor)

First NameLast Name
Participant Email
example@example.com
Parent/ Guardian Contact Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/ Guardian Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
I hereby give permission for photos and/or videos to be taken of me/my child by the Florida Civil Rights Museum, Inc. during the event 'Live the Dream: Youth Excursion | Historical Immersion.
Signature of Participant or Parent/Guardian
Date

MonthDayYear
Date
Location
The Florida Civil Rights Museum, Inc.

Jaquline Y. Perkins | Delatire J. Holinger

Co-Exectutive Directors

P.O Box 6197

Tallahasseee, FL 32314

A public charitable 501c(3) non profit organization

Email:floridacivilrightsmuseum@gmail.com

Website:floridacivilrightsmuseum.org

For More information Contact:

Kristen L. Mathis

(850)848-7632

Facilitator for Youth Engagement
Florida Civil Rights Museum, Inc.
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