The HEAL Project Media and Liability Release
Please fill out one form per person.

The HEAL Project (THP), a California nonprofit public benefit corporation, sometimes makes photo or video recordings of the individuals participating in their programs in order to illustrate the activities in which they are involved. We ask that all individuals participating in THP activities read, acknowledge and sign (or if a minor, have a parent or guardian read, acknowledge and sign) the following:

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Liability Waiver
The participant and/or parent/legal guardian agrees to hold harmless THP, all THP employees, interns, contractors, board members and the owners of any properties made available for THP activities, from any claims, damages, losses and/or expenses arising out of participation in THP activities; and to assume all liability for any and all personal injury, bodily injury, illness or property damage that occurs as a result of participation in such activities. The participant or participant’s parent/legal guardian also warrants that participation in THP activities is voluntary and understand the inherent risks involved in THP activities, and the participants agree to obey all rules and policies mandated by THP personnel. I understand that although I am signing this document today, I intend for this document to be valid and binding now and at all times in the future when I engage in any or all activities at any of The HEAL Project locations.
Photo, Media, and Copyright Release
I give permission to The HEAL Project (THP) to film, tape, photograph, interview, and otherwise record me and/or my child’s involvement in activities sponsored by The HEAL Project. These recordings and all such related material will remain in the property and ownership of The HEAL Project and may be used in advertising or marketing campaigns on The HEAL Project’s website, in its publications, or through any other medium. Media may also be used in reporting to grantors and in their publications. I agree that The HEAL Project may edit, alter, copy, exhibit, publish or distribute recorded voice or image and hereby waive the right to inspect or approve the finished product, as well as any rights to compensation for, or ownership of, such images and/or sounds. I understand that although I am signing this document today, I intend for this document to be valid and binding now and at all times in the future when I engage in any or all activities at any of The HEAL Project locations. The HEAL Project will not release any personally identifiable information in connection with my own or my child’s voice or image without my prior written consent. Personally identifiable information includes: names, phone numbers, residential and email addresses.
*
Required
Signature (Parent or Guardian if participant is under 18)
By entering you name below, you are consenting to the use of your electronic signature in lieu of an original signature on paper.
Participant's Name *
Your answer
Minor's Name (if applicable)
Your answer
Reason for visit:
Please fill out one form per person.
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