Language
  • English (US)
  • Español

  • Rich in Faith Adult Participant Consent

    Register here for your group's Storytelling Seminar

  • At Rich in Faith events, you'll be able to take an experience from your life and create a way to tell it as a story. You could share your story just by telling it, or through an interview, a children's book, as part of a mural, or something else. This form gives the Rich in Faith project permission to share the story you create to inspire others. You can also choose for your story to be part of the project without your name.

  • Where are you participating? Choose the ministry hosting the event.*
  • Format: (000) 000-0000.
    • Consent and Release for Participation and Media - click to open 

    • I hereby consent to participate in the Rich in Faith Project (the "Project") conducted by New Life Centers of Chicagoland, Legendary Communities NFP, and the partner ministry selected above (collectively "Partners").

      As part of this participation, I consent to be photographed, digitally recorded, video taped, audio taped and/or interviewed, either in person or remotely, for the Project and its Partners.

      I consent for these photos, digital recordings, video tapes, audio tapes and/or interviews to be shared for the Project's purposes with third parties who have received written approval from the Project's leaders.

      If selected below, I further consent for the Project and Partners' release of information of my name and my participation in Rich in Faith Project partner organizations' activities.

      I also consent to the Project and Partners' use of my name/photograph/likeness (if selected below) and/or voice/creative work(s) on the Internet or any other electronic/digital media or print media electronic which may include artistic murals displayed in, near, or around Project partner organizations.

      I understand and agree that the Project, Partners, and their authorized representatives retain the right to use any digital or print capture (including video, audio, photographs or likeness) for any purposes stated or related to the above and may be used by the Project in subsequent years.

      I agree to release, indemnify and hold harmless the Project and its Partners' trustees, agents, officers, contractors, volunteers and employees from and against any and all claims, demands, actions, complaints, suits or other forms of liability that shall arise out of or by reason of, or be caused by my participation in the program or by the use of my name, photograph or likeness, voice or creative work(s), on television, radio or film, or on the Internet, or any digital file, or any other electronic/digital/print media or in person event.

      While the Project may send tokens of thanks to its storytellers, it is further understood and I do agree that no monies or other consideration in any form, including reimbursement for any expenses incurred, will become due to me, my heirs, agents, or assigns at any time because of my participation in any of the above activities or the above-described use of my name, photograph or likeness, voice or creative work(s).

      I understand that I may cancel or alter this consent by providing written notice to the Project leaders. I also understand that my consent is valid for above-mentioned media produced within one year of the signature date.

    •  
    • I consent for:*
    • I am consenting for:*
  • Should be Empty: