IGNITE Worldwide Media Consent and Release Form

IGNITE Worldwide Media Consent and Release Form
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IGNITE Worldwide is a 501(c)3 nonprofit STEM education organization that aims to change gender and racial equity in STEM permanently and systematically. We work directly with educators to provide accessible and equitable programming that promotes representation in STEM academics and careers. Through our award-winning program, IGNITE provides engaging, hands-on STEM education that connects students directly with STEM professionals. Learn more at www.igniteworldwide.org


As part of participating in the IGNITE Program, I understand I am consenting to media created depicting the likeness, voice, testimonials, name, and/or school or workplace of the person(s) listed at the bottom of this form for IGNITE Worldwide's use of said media for education, fundraising, advertising, publicity, or any other purpose on behalf of IGNITE Worldwide.

Participants may be asked to complete brief surveys at the end of IGNITE Program Events. Taking part in this survey is voluntary. If Participants or guardians decide not to take part or to skip some of the questions, it will not affect future participation in similar Programs. Data collected for evaluation purposes will be treated as confidential and personal information will not be shared. Your answers will not be reported in any way that may identify you individually; they will be joined with responses by other participants and/or any identifying information will be removed or disguised.

Signing this document gives full permission and authority to IGNITE Worldwide and anyone authorized by the organization, to use, modify, publish, and display media depicting my or my child’s statements, voice, image, and likeness in media relating to IGNITE Worldwide online and in print. I waive any right to inspect or approve the finished version(s) of any created content. I recognize that there is no form of compensation, and I waive all claims to damages based on the use of this media by IGNITE Worldwide. I understand that all media created by IGNITE Worldwide will be done so in good faith and will reflect the ethics of the organization. I also understand that I can revoke this consent for privacy purposes by submitting in writing the information and/or media to be removed to contactus@ignite-worldwide.org. 

Description of media includes, but is not limited to: Webinar, podcast, video, personal story, photo, and/or audio recording created by or given to IGNITE, without payment or any other consideration, to educate and inspire supporters about real-life lived experiences by supporters, volunteers, teachers, alumni, students, or similar.

 

Please fill out the following:

I HAVE CAREFULLY READ THIS DOCUMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.

*Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.

Participating Adult or Parent/Guardian* Full Name
Student/Participant (under 18 years old) Full Name
**IF PARTICIPANT IS A MINOR, UNDER 18 YEARS OF AGE, PARTICIPANT’S LEGAL GUARDIAN MUST SIGN ABOVE AS WELL

If you have any questions, please email contactus@ignite-worldwide.org.