2019-20 General Media Release
I authorize and grant permission to Agenda for Children Out-of-School Time (AFCOST) to use photographs, video or audio taken of me during my participation in their professional development activities for use in any and all electronic and printed AFCOST publications, including but not limited to, newsletters, brochures, AFCOST websites or other social media, and any website or publication that has been approved by AFCOST including City of Cambridge website's, community events, and community media, at AFCOST’s discretion without further notice to me.
- I hereby grant to AFCOST permission to transmit live and/or record for later transmissions, on the internet or in print, my -likeness and/or voice for any lawful purpose, at any time, and to own all copyrights of said media.
- I assign to AFCOST the right to re-use, publish, and otherwise reproduce, modify, and display the same, in whole or in part, and to use my name in connection with the same. I also authorize use of any excerpts of photographs/video/audio taken of me for the purpose of promoting and publicizing AFCOST professional development activities.
- I waive any right that I may have to inspect or approve the finished product or the written copy that might be used in conjunction therewith, or the use to which it may be applied.
- I agree to hold harmless AFCOST's funders, the City of Cambridge, AFCOST directors and employees (and their successors), and the photographers/media creators from any liability, loss, claim.
- I am 18 years of age and I am competent to sign this release and contract in my own name. I have read the foregoing and fully understand the meaning and effect thereof and, intending to be legally bound, I have signed this release voluntarily and without reservation
Sign in to Google
to save your progress.
Please write your full name
Please select which Agenda for Children OST activities that you participate in (Check all that apply)
Communities of Practice
Middle School Network
Quality Improvement System
Do you grant permission as stated herein and expressly authorize AFCOST to use, in whole or in part, your name, likeness, image, spoken words, learning experiences, in all manner and media, as AFCOST determines in their sole discretion?
Send me a copy of my responses.
Never submit passwords through Google Forms.
This form was created inside of Cambridge Agenda for Children Out-of-School Time.