Student Video Creator 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 or The Rotary Foundation. 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) in its "Distributions" (publications, news releases, website, social media, online and in any other communications) related to its  mission to protect the environment for a sustainable future. The Media Creator is defined as the main person or lead in creating the video.  

I grant ESAT permission to use my “Media” in its “Distributions”. I understand that ESAT will not pay me to record my name, image or personal story/information, and I release ESAT from all damages and liabilities in relation to the making and use of the Media and its Distributions. 

I attest that I am both the owner and creator of the video I am submitting listed below. 

This video:
(1) Only contains images or artwork that I or my team created and/or have permission to use.
(2) Does not contain media owned by a third party or subject to other copyright restrictions
(3) Does not not contain material that violates or infringes on the rights of others, including, but not limited, to privacy, publicity, tort or intellectual property rights (including copyright, trademark or patent rights) or constitute copyright or trademark infringement.


In the event that the ownership of the media is contested, I will take responsibility for possible legal actions, and ESAT disclaims responsibility for use of this media.

I understand that ESAT does not share individuals’ personal information without explicit permission.

This release is the entire agreement between ESAT and the Media Creator and is governed by the laws of the state of Idaho, USA.

For more information email us at: Communications@ESRAG.org .   Form created October 2023

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Email *
If the student Media Creator is 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 student Media Creator(s) is/are under 18, write in the email of the parent legal guardian or legal representative below: *
If the student Media Creator is under 18, write in the phone number of the parent legal guardian or legal representative below: *
Name of the student Media Creator  


 *

Email for the student Media Creator *
Age of the student Media Creator at time of submission. (Must be between 16 and 19)


 *
Please list other creators' and/or models' names with their emails *
This video submission is three to four minutes long and was submitted. *
Title of submitted video entry:  *
Submitted entry's Vimeo or youtube file name:   *
Date of submission *
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Name of school that creator(s) are attending -   *
Location(s) in Idaho where video was filmed:  city, county *
Write the student creator and parent/guardian mobile number.  ESAT will only use this if we have questions about the film, this form, or winner announcement.  *
By clicking YES, the student creator and/or parent/guardian agrees that all people (models) whose faces are recognizable in the video have submitted the Youth Eco Film Fest: Spotlight on Climate Action ESAT Model Release Form.  (If the model is a minor, this form needs parental/ guardian signature.)   *
If the student creator is a minor, by checking this box,  I, the parent or guardian of the student creator, agree to the terms above
or
If student creator is 18 or older, by checking this box, I, the student creator, agree to the terms above.
 *
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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