AUTHORIZATION TO USE PHOTOGRAPHS AND/OR AUDIO-VISUAL

By checking yes below I hereby authorize CoolTechGirIs and its partners to use, reproduce, and/or publish photographs and/or video that may pertain to me, including my image, likeness and/or voice without compensation. I understand that this material may be used in various publications, public affairs releases, recruitment materials, broadcast public service advertising (PSAs) or for other related endeavors. This material may also appear on the organization's Internet Web Page. This authorization is continuous and may only be withdrawn by my specific rescission of this authorization. Consequently, the organization may publish materials, use my name, photograph, and/or make reference to me in any manner that CoolTechGirls deems appropriate in order to promote/publicize their program/service opportunities.

WAIVER

For adults I agree to this waiver for myself/ my child to be featured in promotional photos and or videos with CoolTechGirls and its partners, Cybervation Inc., and others.
                                                         
In consideration of being allowed to volunteer or participate in any way in the program, related events and/or activities, the adult or parent/guardian signing this form acknowledges, appreciates and agrees that:

1. I (Parent/Guardian/Adult) KNOWINGLY AND FREELY ASSUME ANY RISK, both known and unknown, and assume full responsibility for the participation of the volunteer named; and

2. I (Parent/Guardian/Adult) willingly agree to comply with the stated and customary terms and conditions for participation and volunteering. If however, parent/guardian/adult observes any unusual significant hazard during volunteer's presence or participation, parent/guardian/adult will remove said volunteer from participation and bring such to the attention to the nearest official immediately; and,

3. I (Parent/Guardian/ Adult), for myself and on behalf of my heirs, assigns, personal representatives and next to kin, HEREBY RELEASE AND HOLD HARMLESS CoolTechGirls, Cybervation Inc., their officers, officials, agents and/or employees, other participants, volunteers, sponsoring agencies, sponsors, advertiser, and if applicable, owners and lessors of premises used to conduct the event {“Releasees”} WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, OR LOSS OR DAMAGE to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASES OR OTHERWISE.

4. I (Parent/Guardian/ Adult) HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I (Parent/Guardian/ Adult) HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

5. I further grant CoolTechGirls & its partners both named and unnamed, the right to photograph, videotape, and/or record me and/or my child and to use my or my child’s name, face, likeness, voice and appearance in connection with advertising, and promotional materials without reservation.

6. I would like to receive free email promotions to the email address provided, I may unsubscribe to emails from CoolTechGirls at any time.

If the volunteer is under 18 years old at the time of this form submission, a legal guardian must check the previous box and type their first and last name below in agreement of their child volunteering.