BIG OpenDoor Media Consent and Release Form for Youth Participation
BIG OpenDoor Media (BOM) is a free, weekly after-school program for Brookline area youth, aged 10-18. The program is designed to involve students in community activism, organizing and social justice issues while learning to use video and new media production skills. For 2 hours every week, students come to our studios, producing news, PSAs, and short documentaries. The process is youth-driven, with mentoring and support from Brookline Interactive Group (BIG) staff. The youth will choose the topics, develop the scripts, conduct interviews, shoot and edit short videos, and crew productions in order to tell their stories. These stories will be broadcast, giving the youth a platform for their storytelling as well as a reservoir of resume-building media clips.

Our interactive curricula includes; foundations of storytelling, technical skills for media production and “soft” skills such as communication, listening, organization, public speaking, presentation of ideas, and professional demeanor. While youth take part in this program based on their passion for media creation, the benefits extend beyond the technical and include important skills and experiences that will be essential in their transition to the world of work.

Skill-development will include pre-production and planning, cameras, lighting, sound, filming techniques, post-production techniques, graphic design, and the art of story-telling. As participants gain more experience and confidence with their skills, they will be called upon to mentor the newcomers and less-experienced youth.

Peer Mentors and Youth Internships: For those youth who want to take a deeper dive into career exploration in media arts, we are offering a peer mentor model that gives motivated youth a specialized leadership role. Mentored by staff, the youth learn to become mentors and leaders themselves.

This training helps youth to both realize their capacity as leaders and to recognize and respect peer leaders. Finally, BIG OpenDoor Media fuels creativity, problem solving skills and helps participants develop unique job skills that are increasingly valuable in the digital age.

Brookline Interactive Group supports this youth program as a service to the community. We do so at a financial loss, providing training and equipment to the youth without payment from the participants or their families. If you would like your child to participate in this event, please complete, sign, and return the following Consent and Release Form, acknowledging that they are participating at their own will and with your consent. As parent or legal guardian, you and your child remain fully responsible for the actions and conduct of your child.

If you would like to make a donation to BIG - You can do so here in the name of BIG OpenDoor Media: https://brooklineinteractive.org/donate/

When: Free, every Wednesday from 4-6pm (youth can stay for Intro to VR class from 6-8pm)
Who: Open to all youth ages 10-18 years of age
Where: 46 Tappan Street, 3rd Floor
Email address *
Image/Sound/Media Release *
I grant to Brookline Interactive Group (BIG) the right to create, use, reproduce, assign and/or distribute photographs, films, video, digital images and sound recordings of this participant or materials they create at any time without prior notification for any purpose. All participants are granted unrestricted use of the recordings for any purpose, provided they fall within the creative commons license under which the recordings are released.
Transportation *
I understand that OMF does not provide transportation to the participants of the group. At times, the youth may elect to separate into smaller production groups and go out into the community to film interviews or community events. BIG does not provide transportation, nor do we coordinate such transportation, so if you do not wish for your child to provide or receive transportation from other participants, we encourage you to have that conversation with your child. BIG assumes no liability for the transportation of youth group participants.
Participation- Liability and Release *
As the parent/guardian of the minor child named below, I give permission for him/her to participate in BIG OpenDoor Media (BOM). BIG is not responsible for the personal property of your child during the program. Please encourage your child to keep track of their belongings at all times. Additionally, by signing I release the BIG from any liability or responsibility for any injuries or damages he/she may cause or suffer as a result of participation. Participants in BOM are responsible for any damages or loss of equipment in their care. If you do not accept this responsibility, your child will not have to access to video production equipment at BIG.
Medical Considerations
Please list any conditions or allergies that we should be aware of.
Your answer
Youth's Name *
Your answer
Youth's Age *
Your answer
Print Name (Parent/Gaurdian) *
Your answer
Relationship to Youth *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Postal Code *
Your answer
Primary Phone of Parent/Guardian *
Your answer
Primary Email of Parent/Guardian *
Your answer
Phone Number of Youth (if applicable)
Your answer
What is your youth's racial or ethnic identity (check all that apply) *
What is the primary language of your youth? *
How would you describe your youth's gender? *
Is your youth living with a mental or physical disability? *
Please use "other to describe disability"
Required
Which of the following categories best represents your household income level? *
Indicate your Education level *
Required
What is the primary way your family accesses the internet? *
How did you hear about us? *
What skill level is your child in each category? *
Please rate their comfort level 1-10.
1
2
3
4
5
6
7
8
9
10
Technology
Teamwork/Social Skills
Artistic/Creativity
Interpersonal Communication
Public Speaking
Parent/Gaurdian (signature) *
Type your name to e-sign
Your answer
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy