Clone of Let Your Light Shine 2025 Permission to Attend & Photography & Media Release Form

Photography & Media Release Form for Participants
This letter confirms the agreement between the undersigned parent/guardian and Success Charities, regarding the participation of participant's name . in the "Let Your Light Shine" Special Education Prom, to be held on March 7, 2025, at the Pavilion at the Lake, Atascadero, California. As the legal parent/guardian of the minor participant, I hereby grant permission for my child to be photographed, videotaped, or digitally recorded during the event.
Initials*
I, the undersigned parent/guardian, hereby irrevocably grant to Success Charities perpetually, exclusively, and for all media throughout the world (including print, non-theatrical, home video, CD-ROM, the internet, and any other electronic medium presently in existence or invented in the future), the right to use and incorporate (alone or together with other materials), in whole or in part, photographs, digital recordings, or video footage taken of my child as a result of their participation in the "Let Your Light Shine" Special Education Prom.
Initials*
I agree that I will not bring or consent to others bringing a claim or action against Success Charities on the grounds that anything contained in the Property or in the advertising and publicity used in connection herewith is defamatory, reflects adversely on my child, or violates any other right whatsoever.
Initials*
Disclaimer: I understand and agree that Success Charities and its representatives shall not be held responsible or liable for any injuries, damages, or losses that may occur during the "Let Your Light Shine" Special Education Prom event. I hereby release and hold harmless Success Charities from any claims, demands, actions, causes of actions, suits, costs, expenses, liabilities, and damages whatsoever that may arise during or as a result of my child's participation in the event.
Initials*
This agreement shall not obligate Success Charities to use any rights granted hereunder, or to prepare, produce, exhibit, distribute, or exploit the property. Success Charities shall have the right to assign its rights hereunder, without my consent, in whole or in part, to any person, firm, or corporation.
Permission To Attend Form
Please let us know the following information:
Name of Participant*

First NameLast Name
Gender*

MaleFemale
T-Shirt Size*
Will you be staying? (The event is fully chaperoned, but we have an area off to the side for parents/guardians who do want to stay)*

YesNo
Parent/Guardian's *

First NameLast Name
Once we have this permission slip, you will receive further instructions for how to pick up your ticket and make appointments for hair styling, make up, nails, prom attire, flowers.

We look forward to a special evening for our special guests.

Any questions? info@successcharities.org or call 805.226.5722
Agreed to and Accepted:
Parent/Guardian's Name*

First NameLast Name
Signature*

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Date*

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Date
Email*
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Phone Number*
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Photography & Media Release Form for Participants

Permission To Attend Form

Agreed to and Accepted: