NewsDepth Participant Release

"NewsDepth" Participant Release
Student/Participant Name*
School Year*
Example: Sept. 2021 - May 2022
I hereby authorize Ideastream Public Media and its licensees and assigns to record the appearance and/or performance of the above named and to edit these recordings at its discretion, to incorporate these recordings into a television broadcast, radio broadcast and/or internet or any other digital distribution and to use and license other entities to use such recordings in any appropriate manner worldwide and in perpetuity, including unrestricted use for purposes of publicity. I further acknowledge that Ideastream Public Media owns all rights to the aforementioned recordings. I hereby agree to indemnify Ideastream Public Media for all loss, damage and liability whatsoever arising out of my appearance. I warrant and represent that I am under the age of 18 years and that I am free to enter into this agreement.
Student/Participant Name*
Student/Participant Signature*

Clear
Today's Date*

MonthDayYear
Date
Student/Participant Address*

Street Address

Street Address Line 2

City, State, Zip CodeState / Province

Postal / Zip Code
Student/Participant Phone*
Can be the same as parent/guardian.
I am the parent and/or guardian of the above-named minor and I endorse the above statement on their behalf.
Parent/Guardian Name*
Parent/Guardian Signature*

Clear
Today's Date*

MonthDayYear
Date
Parent/Guardian Address*

Street Address

Street Address Line 2

City, State, Zip CodeState / Province

Postal / Zip Code
Parent/Guardian Phone*
Parent/Guardian Email
A completed copy of this form will be sent to the above email.
Optional school information:
Teacher Name
School Name
Teacher Email
A completed copy of this form will be sent to the above email.
Should be Empty:

"NewsDepth" Participant Release