Media Release- Teen Talk
Everyone must complete this release form. If you are Under 18, this release form will need to be completed by a Parent or Guardian.
Email *
Participant's Name *
Parent or Guardian's Full Name ( If Under 18 years of Age)
Home Address *
I hereby grants permission to KCEP FM Public Radio Station, Economic Opportunity Board of Clark County (EOBCC), it's agents and assigns, to use above-named Teen Talk Participant’s photo or video and likeness for the purpose of promotion by KCEP TEEN TALK RADIO PROGRAM for all forms, media and manners, for the following but not limited to news releases photographs, video, audio, website marketing advertising, trade promotion, exhibition for an indefinite period of time. I give unrestricted permission for images videos and recordings of named Teen Talk Participant to be used in print, video, digital and internet media. I agree that these images and or voice recordings may be used for a variety of purposes and that these images may be used without further notifying me. I further acknowledge that I will not be compensated for these uses and KCEP FM Public Radio Station and EOBCC own all right to the images, videos and recordings and to any derivative works created from them. I waive any right to inspect the uses of any printed or electronic copy. I hereby release KCEP FM and EOBCC and its agents and assigns from any claims that may arise from these uses including without limitation claims of defamation or invasion of privacy or of infringement of moral rights or rights of publicity or copyright. This release expresses the complete understanding of the parties. I HAVE READ AND AGREE TO THE TERMS PRESENTED IN THIS RELEASE. *
How are you related to the Participant named above? *
What is today's date *
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