By signing this contribution form, you are agreeing to the Beta Change Terms & Conditions below:

As a guest contributor to Beta Change blog and/or social media accounts and/or a Beta Change Minisode guest, I hereby give my consent to Beta Change to use my child/ward's image and likeness and/or any written statements in videos, publications, advertising or other media activities (including the Internet) without expectation of compensation or other remuneration, now or in the future. This consent includes, but is not limited to: (a) Permission to interview, film, photograph, tape, or otherwise make a video reproduction of them and/or record their voice, including for use in live broadcasts; (b) Permission to use their name; and (c) Permission to use quotes from the interview(s) (or excerpts of such quotes), the film, photograph(s), tape(s) or reproduction(s) of them, and/or recording of their voice, in part or in whole, in its publications, in newspapers, magazines and other print media, on television, radio and electronic media (including the Internet), in theatrical media and/or in mailings for educational and awareness. I hereby waive any right to inspect or approve the finished photograph/video or advertising copy or printed matter that may be used in conjunction therewith or to the eventual use that it might be applied. This consent is given in perpetuity, and does not require prior approval by me.

I am the parent or legal guardian of the below named child. I have read this release before signing below, and I fully understand the contents, meaning and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in email to betachangenetwork@gmail.com prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.