FOR PARENTS/GUARDIANS TO COMPLETE: PLEASE WRITE YOUR NAME AND RELATIONSHIP TO STUDENT ON LINE BELOW if you agree with this statement:
I consent to the use and disclosure of the image, quotes, name, the participation in interviews, and the taking of photographs, recordings, and videos of the Student named above by the Impact 100 NYC and Impact 100 NYC invited members of the press for Impact 100 NYC sponsored events. I grant Impact 100 NYC and invited members of the press the right to disclose, edit, use, and reuse the Student’s image, quotes, name, and interviews, and photographs, recordings, and videos of the Student for Impact 100 NYC's nonprofit and public press purposes. This includes use in print, on broadcasts, in online spaces (such as the Impact 100 NYC website and social media accounts and those of the press), and all other forms of media.
By writing my name below I also release the Impact 100 NYC, its agents, and volunteers from all claims, demands, and liabilities in connection with the rights granted above.