United Through Reading Digital Consent Form
Sign in to Google to save your progress. Learn more
Email *
1. I, the undersigned, hereby authorize United Through Reading®, a California nonprofit corporation, to receive, take and/or have taken photographs, DVDs or videos depicting me, either alone or in a group, recordings of my voice, and written statements or testimonials. Moreover, I hereby give United Through Reading and any person or entity associated with United Through Reading the royalty-free, irrevocable right to use, reproduce, adapt, display, and/or distribute for any purpose whatsoever related to the business and educational activities of United Through Reading.
2. On behalf of myself, my heirs, successors, assigns, personal representatives, and all other persons, I hereby release United Through Reading, and its successors, agents, employees, assigns, and licensees from any and all claims and causes of action arising from the use of the photographs, written statements, DVDs or videos. I confirm that United Through Reading is the sole owner of all rights including copyrights and moral rights.

3. When applicable, I agree to create and/or allow my child, named below, to use my United Through Reading app account to participate in United Through Reading programs and challenges. Recordings made by my child on the UTR app will not be used or shared by United Through Reading without my permission.

4. When applicable, I agree to allow my child to be a United Through Reading Social Media Ambassador and share United Through Reading approved content on his/her social media accounts.
By typing my name I agree to be bound by the terms of this Consent and Release. *
Email Address to contact you *
Phone number and address where we may contact you *
Name of child (if applicable) 
Relationship to child
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of United Through Reading. Report Abuse