I agree that the information that I have provided to Collective Souls, Incorporated (CSI) is correct.  I understand that if my application is accepted, I am required to conduct myself in a professional manner, work the assigned hours agreed upon and to provide a background check for the purposes and safety of the organization.   

I give my permission to CSI, and those acting with permission and authority of CSI, permission to use all photographs, video, or other images or recordings that CSI has taken of me or in which I may be included in for program purposes which can include website, promotion, brochures and other media marketing materials.

I am fully aware that my likeness may appear in materials available to youth, parents, or staff of CSI, and individuals outside of the CSI community. I understand that I will not be paid for these photographs and/or video footage and have no rights to them. I am participating solely as a volunteer.

I waive any rights to inspect or approve the finished photograph/video or advertising copy or printed material that may be used in conjunction with or to the eventual use that it might be applied.

I release CSI, its, officers, employees, and agents, from any and all claims of harm and liability as a result of any distortion, blurring, or alteration, optical illusion, or use in composite form, either intentionally or otherwise which may occur from making, showing, using, or distributing these photographs/video.

If you agree to all the information on this form, please type your full name. 

If you are under the age of 18, please have parent/guardian type their full name and phone number.