DW Green Institute, Green School
and DW Communications & Media
Registered Department of Labor
MEDIA RELEASE CONSENT FORM
DW Communications & Media has permission to photograph my child, company, company representative, business location and/or premises. I hereby give my consent for the image and likeness of ______________________ to be videotaped, audio-taped, and/or photographed for the following uses only.
I further authorize DW Communications & Media and their counterparts to use this electronic media and/or photograph(s) in whole or in part for: recruiting brochures, newsletters, and magazines and to use photographs on display boards. I agree to refrain from instituting, pressing,
or in any way aiding any claim, demand, action, or cause of action for damages, costs, compensation, or fees against the same in connection with such use. This waiver includes usage of this media in an appropriate manner, which may include electronic and photographic reproductions thereof, for the production of educational, instructional, promotional, or institutional advancement materials to support the educational and outreach
activities of DW Communications & Media. I hereby waive any right that I may have to inspect or approve any use of this electronic media and/or photographs and I release DW Communications & Media and its counterparts from all liability, which could result from its use.
I release DW Communications & Media and its counterparts from liability, which is not the result of DW Communications & Media's negligence or willful misconduct and which could result from its use of this electronic media or photographs in the manner stated hereinabove.
I waive any right to royalties or other compensation arising from or related to the use of the electronic media or photographs in the manner stated hereinabove.
PARTICIPANTS AGES 18 YEARS OLD AND YOUNGER MUST CLICK THE FORM BELOW FOR PARENT/GUARDIAN TO CONSENT. THIS FORM MUST BE FILLED OUT AND SUBMITTED TO THE FOLLOWING EMAIL: [email protected] OR PARTICIPANTS WILL NOT BE ABLE TO COMPETE.
PERSONAL LIABILITY AND MEDICAL RELEASE FORM
I hereby agree to release DW Green Institute Inc., Green School, DW Communications & Media, UNA-USA, SPSC, its representatives, agents, servants, and employees from liability for any injury to the named person, resulting from any cause whatsoever occurring to the named person at any time while participating in the competition, including travel to and from the recognition and honor ceremony, excepting only such injury or damage resulting from willful acts of representatives, agents, servants, and employees. I voluntarily assume all risks and dangers relating to the conference, whether occurring prior to, during or after the event.
I do voluntarily authorize the DW Green Institute Inc., Green School, DW Communications & Media, UNA-USA, SPSC medical services coordinator, assistants and/or designees to administer and/or obtain routine or emergency diagnostic procedures and/or routine or emergency medical treatment for the named person as deemed necessary in medical judgment. Parents/guardians of the participant will allow emergency medical treatment to be administered as needed. Any further treatment will require parental/guardian consultation.
I agree to indemnify and hold harmless DW Green Institute Inc., Green School, DW Communications & Media, UNA-USA, SPSC and said medical services coordinator and/or assistants and designees for any and all claims, demands, actions, rights
of action, and/or judgments by or on behalf of the named person arising from or on account of said procedures and/or treatment rendered in good faith and according to accepted medical standards.
Having read and understood completely the “Code of Conduct” of DW Green Institute Inc., Green School, DW Communications & Media, UNA-USA, SPSC, I do hereby agree to follow the procedures and practices described. I fully understand that this is an educational activity and will, to the best of my ability, apply myself for the purpose of learning and will uphold at all times the finest qualities of a person representing DW Green Institute Inc., Green School, DW Communications & Media, UNA-USA, SPSC.
Audio- or videotaping of conference speakers is not permitted.
NOTE: All persons under the legal age must have a parent or guardian check this form (see another side). If you are age 18 or older, please indicate that on the other side of this form. Otherwise, this form will be returned for parent/guardian approval. All participants must check this form.