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Photography Consent& Media Release Form for Minors
Minor Release Form - to be filled out by minor's parent or guardian
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I  (TYPE PARENT OR GUARDIAN'S NAME BELOW) hereby grant permission to the South Bay Workforce Investment Board (SBWIB) and the South Bay One Stop Business & Career Center, its employees or representatives, to take and use printed or electronic publications of (TYPE MINOR'S NAME BELOW) story, name and images (all formats) including photographs/digital images, videos, audio recordings, quoted remarks, written material, educational materials, PowerPoint presentations, other electronic, written or hard copy forms of communication and any other form of communication for the purpose of publishing or republishing a success story and images, this includes publicizing the material in newspapers, on websites, through social media, at meetings and public events or at any other venue the SBWIB and One Stop Business & Career Centers may participate. I hereby acknowledge that participation is voluntary, any form of compensation will not be received and all content as described above will remain the property of the SBWIB free from any claims by me or anyone acting on our behalf. *
I warrant and represent that I am the father/mother/guardian (INPUT BELOW) of (TYPE MINOR'S NAME BELOW), the minor named above. I hereby release the SBWIB and it’s representatives from any and all claims and demands that may arise out of or in connection with the use of the materials listed above. I have read the above authorization, release and agreement, prior to its execution. This release shall be binding on upon me and my heirs, legal representatives and assigns. Should we desire to rescind this permission we will do so with 10 days written notice to the address below. *
Parent or guardian's name *
Address *
City *
Zip/postal code *
Phone *
Email *
Date of birth *
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Today's Date *
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Signature (type name) *
South Bay Workforce Investment Board
PDF version available at https://tinyurl.com/yca5so6b
Phone: (310) 970-7700; Email: info@sbwib.org
11539 Hawthorne Boulevard, 5th Floor Hawthorne, CA 90250

This WIOA Title 1 financially assisted program or activity is an equal opportunity employer/program. Auxiliary aids and services are available upon request to individuals with disabilities by calling in advance to 310-680-3700 or CRS 1-800-735-2922.
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