Tribal Youth Fellowship Video Project

Tribal Youth Fellowship Video Project

Media Release & Video Submission Page
What is your name?*

First NameMiddle NameLast Name
Which tribe(s) or nation(s) are you connected to?*
What is your date of birth?*

MonthDayYear
If you are under 18, we will need your parent or legal guardian to sign an additional form.
Today's Date*

MonthDayYear
Age Calculation
What is your email address?*
What is your phone number?*
Please enter a valid phone number.
We need both an email address and a phone number to send you your gift card. Please make sure that you have entered the correct information! If you enter an email address that you cannot access, we cannot issue you a second gift card.
Would you like to receive an email when the final video is posted?*
Would you like to receive an email about other projects or opportunities with the Tribal Youth Fellowship?*

Appearance Consent & Release Form

Youth Contributor
Purpose of this form:

We are so excited to hear what you have to say about Native youth, {FullName}! We want to be sure that we have your permission to use this video for our project. This form is a way for us to ask for and record your permissions to use your video.

You must sign this form before you can upload your video.

Some of the language used in this form may be difficult to understand. Below are some bullet points that help to explain what the form is saying. If you are confused or uncertain about anything in this form, please reach out to us with any questions! You can talk to Dee by phone or text at 347-352-7472 or by email at mandiyand@innovatingjustice.org.

When filling out the form, you should only check the boxes that you understand and voluntarily agree with.
What The Form Says
1. The first point of the forms asks if you understand who we are and why we are asking for these videos.
2. Next, the form asks for your permission to edit your video. For this project, we will be editing videos from many young people together to create longer videos. We might shorten your video, or splice it with some other videos, to draw attention to a theme or idea. We might also zoom in on your video. We might also take the audio for your video and play it over a different image. We will not edit your video to create the appearance that you said something you didn't actually say, or appear as a different person.
3. This form also asks for your permission to allow other organizations to use your video for any reason.
4. The form then asks you to give up the right to sue our organization based on how we use or edit your video.
5. Finally, the form asks you to confirm that you know that you can’t change your mind about signing this form after you’ve signed it.
The last portion of the form asks if you are 18 years or older. If you are not, then a parent or guardian must sign an additional part of the form for you.
Please check off the statements below that you have read, understood, and voluntarily consented to.*

I understand the Center for Justice Innovation (the “Center”) is planning to make one or more videos about the Tribal Youth Fellowship Program (the “Program”).I authorize the Center freely and without restraint to record and edit my name, likeness, image, voice and interviews by various mechanical means (the “Recordings”) taken at Program activities.The Center may use and authorize others to use Recordings for any purpose whatsoever.The Center, its successors and assigns, shall own all right, title and interest, including copyright, in and to the Recordings, to be used and disposed of without limitation and without compensation as the Center shall in its sole discretion determine.I expressly release the Center and each of its officers, agents, employees and volunteers from any causes of action in law or equity I may have or may hereafter acquire including but not limited to, libel, slander, invasion of privacy, copyright or trademark violation, right of publicity, or false light or other claims arising out of or in connection with the use of my name, likeness, image, voice and interviews as authorized under this consent.I shall not have the right to terminate or rescind this Release or enjoin or restrain the distribution or exhibition of the Recordings.I hereby certify that I am eighteen years old or older, and that I have read, understood, and agreed to the foregoing.
Participating Incentive

For participating in this project, I understand that CJI will provide me with a $25 incentive (electronic gift card) upon verification of my video.
Signature*
Date*

MonthDayYear
Date
Hour MinutesAM/PM Option
If you are under 18, the next page of the form is for your parent or guardian to sign.

Consent of Parent/Legal Guardian

Must be completed for Youth Contributors younger than 18 years old
We are so excited to hear what {FullName} has to say about Native youth! We want to be sure that we have your permission to use your child's video for our project. This form is a way for us to ask for and record your permissions to use your child's video.

You must sign this form before your child can upload their video.

Some of the language used in this form may be difficult to understand. Below are some bullet points that help to explain what the form is saying. If you are confused or uncertain about anything in this form, please reach out to us with any questions! You can talk to Dee by phone or text at 347-352-7472 or by email at mandiyand@innovatingjustice.org.
What The Form Says
- The form first says that by signing, you are claiming that you are the parent or legal guardian of your child.
- The next point says that by signing, you confirm that you read the previous part of the form that your child signed. You also agree to your child accepting all the terms of the previous form.
- Next, the form says that by signing, you accept responsibility to make sure that your child does not try to sue our organization based on how we use their video.
- Finally, by signing, you also give up the right to sue our organization based on how we use or edit your child's video, and you agree that you do not have more rights than your child over their video.
The individual {FullName} who signed the attached Consent & Release (the "Youth Contributor") is under 18 years of age and/or is unable to grant consent. By signing below, I represent and warrant that (1) I am the Youth Contributor's parent and/or legal guardian and have the full right to give and sign this Consent & Release, (2) I have read and understood the Consent & Release, and I agree to, and accept, all of its terms and conditions, (3) I am responsible for the Youth Contributor fulfilling all Consent & Release obligations, and (4) I agree that I too shall be bound by all Consent & Release obligations and that I have no greater rights under the Consent & Release than the Youth Contributor. I will receive a copy of this form upon providing my email address.
Accepted and Agreed:
Parent/Guardian Full Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.
Signature*
Date*

MonthDayYear
Date
Hour MinutesAM/PM Option

Upload your video!
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Tribal Youth Fellowship Video Project

Appearance Consent & Release Form

Purpose of this form:

You must sign this form before you can upload your video.

What The Form Says

Participating Incentive

If you are under 18, the next page of the form is for your parent or guardian to sign.

Consent of Parent/Legal Guardian

You must sign this form before your child can upload their video.

What The Form Says

Accepted and Agreed:

Upload your video!