Model Release Form, Youth Eco Film Fest: Spotlight on Climate Action,  Rotary ESAT 

The Environmental Stewardship Action Team (hereafter ESAT) provides environmental leadership within Idaho's Rotary District 5400. In support of Rotary International's new environmental area of focus, ESAT’s mission is to promote and facilitate environmental stewardship projects and practices across District 5400 Rotary family. ESAT operates in accordance with Rotary International’s policies, but is not an agency of, nor controlled by Rotary International. ESAT includes any member of ESAT, or its affiliated organizations, any volunteer working with an ESAT team or participating in an ESAT sponsored activity, or any party contracting with ESAT.
 
ESAT’s work includes sharing information and educational materials. These materials and products are enhanced by the sharing of "Media" (photos, video recordings, audio recording, or other media) of people speaking about, engaged in, or benefitting from activities to protect the environment. ESAT and the person named below (hereafter Model), agree that ESAT may use the Model’s image for all the purposes consistent with the conditions listed below. If Model is under 18, the Model's parent, guardian, or other legal representative will complete this form. 

The Model (or if under 18, parent/guardian) agrees that the student Media Owner/Creator has the right to record and use the model's image, voice, their story, and name as designated, for this video contest. The Model agrees that ESAT may use their image, voice, or story, for purposes, including but not limited to informational, educational or motivational materials on the web, print, video, or audio recordings, without time limitation. 

I grant Rotary District 5400 and partner organizations permission to use my likeness and voice in a photograph, video or other digital media in any of its publications including web-based publications without payment or other consideration.

  • The Model agrees that the Media Creator taking the recording owns the recording and that the Model has no ownership rights to the recording.
  • The Model gives ESAT permission to share the recording with other parties, including other Rotary orginations.
  • The Model agrees to hold harmless ESAT, its affiliates, Rotary members, volunteers, or contractors for activities related to this video contest. 
ESAT does not share individuals’ personal information without explicit permission.  This release states the entire agreement between ESAT and the Model and is governed by the laws of the state of Idao, USA.

For more information email communications@ESRAG.org.  Form created October 2023. 

The email below will receive a copy of this form.  If model is under 18, provide guardian's email. 

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Email *
If Model(s) is/are under 18, their parent, legal guardian, or legal representative must fill out the following form.   Write the name of the parent, legal guardian or representative below: *
If Model(s) is/are under 18, write in the email of the parent legal guardian or legal representative below: *
Name of Model(s)  *
Models' mobile number(s). ESAT will only use this if we have questions about the film, this form, or winner announcement.   *
By checking this box, Model agrees to the terms above *
If Model is under 18, I, the parent, legal guardian, or legal representative agree to the conditions above.
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E-Signature:  Type the name(s) of responsible party (student or guardian) below in lieu of signature.  *
A copy of your responses will be emailed to the address you provided.
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