Prom Scholar is a crowd funding campaign that uses social media to raise money. Every year we make a video with the students talking about the project we also reach out to press help raise money. The scholar is also required to participate in all events related to Prom scholar. This consent form must me signed in order for us to proceed with this project.
I hereby give my consent to Prom Scholar, its affiliates and agents, to use my image and likeness and/or any interview statements from me in its publications, advertising or other media activities (including the Internet). This consent includes, but is not limited to:
(a) Permission to interview, film, photograph, tape, or otherwise make a video reproduction of me and/or record my voice;
(b) Permission to use my name; and
(c) Permission to use quotes from the interview(s) (or excerpts of such quotes), the film, photograph(s), tape(s) or reproduction(s) of me, and/or recording of my voice, in part or in whole, in its publications, in newspapers, magazines and other print media, on television, radio and electronic media (including the Internet), in theatrical media and/or in mailings for educational and awareness.