G4C STUDENT MEDIA RELEASE FORM
MEDIA CONSENT FORM TO PHOTOGRAPH, FILM OR VIDEOTAPE A STUDENT FOR NON-PROFIT PURPOSES

I hereby consent to the above named students’ participation in the G4C Game Jam on March 12, 2022, hosted by Two Bit Circus Foundation, and non-profit Games for Change (G4C). I understand that the game jam will be hosted on the digital platform Zoom - and that students will interact virtually with other students and G4C staff and partners.
 
I also consent to the taking of photographs, video and media (such as quotes or interviews) of the Student named above by non-profit Games for Change (G4C). I understand that the media may be made available publicly through the G4C Student Challenge website (www.gamesforchange.org/studentchallenge) and on program social media channels including YouTube, Facebook and Instagram. I also grant to G4C employees the right to edit, use, and reuse said products for non- profit purposes including use in print, on the internet, and all other forms of media.

I hereby release the organization and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above.

Games for Change is a 501(c)(3) non-profit organization.
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Student Name (First Name, Last Name) *
Student's School *
Parent/Guardian full name (This will act as a digital signature) *
Parent's Email Address *
What is your relationship to the Student? *
Phone Number *
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