Warner Robins Kappa League

Training For Leadership
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PUBLICATIONS, VIDEO, INTERNET CONSENT AND RELEASE AGREEMENT
Participants in the Warner Robins Kappa League will occasionally be a part of publicity, publications, and/or public relations activities for the Warner Robins Kappa League and/or the Macon-Warner Robins Alumni Chapter of Kappa Alpha Psi Fraternity, Inc. In order to ensure your consent for your Kappa Leaguer to participate in these publicity activities, please sign and return this form.
 
The form referenced below indicates approval for the Kappa Leaguer’s name, picture, work, voice, or verbal statement to appear in Kappa-related, foundation, or Kappa League press releases, publicity or publications, videos, or on the Warner Robins Kappa League social media pages and the Macon-Warner Robins Alumni Chapter of Kappa Alpha Psi website. For example, pictures and articles about Kappa League activities may appear in local newspapers or Kappa publications (such as the Kappa Khronicle or the The Kappa Alpha Psi Journal). These pictures and articles may or may not personally identify the Kappa Leaguer. The pictures, videos, and artwork may be used by the Fraternity, Foundation, or Kappa League in subsequent years.
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AGREEMENT
The Kappa Leaguer and parent/guardian release to the Macon-Warner Robins  Alumni Chapter of Kappa Alpha Psi Fraternity, Inc. and the Warner Robins Kappa League the student’s name, voice, verbal statements, and photographs (video or still) and consent to their use by these organizations.
 
The Warner Robins Kappa League agrees that the Kappa Leaguer’s name, voice, verbal statements, photographs will only be used for public relations, public information, Kappa League, Fraternity, or Foundation promotion, publicity, and instruction.
 
The Kappa Leaguer and parent/guardian understand and agree that no monetary consideration will be paid; consent and release have been given without coercion or duress; this agreement is binding upon heirs and/or future legal representatives; this photo, video, artwork or Kappa Leaguer statement may be used in subsequent years.  If the Kappa Leaguer and parent/guardian wish to rescind this agreement, they may do so at any time with written notice.

Effective Date of Agreement *
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Kappa Leaguer’s Full Name *
Kappa Leaguer’s Electronic Signature *
Parent/Guardian’s First and Last Name *
Parent/Guardian’s Electronic Signature *
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