PHOTO/VIDEO/AUDIO RELEASE FORM

1. Name of Participant (person participating in the program)

First Name

Last Name

2. I am 18 years of age or older (If yes, skip questions 3 , 4, 6, & 7))

3. I am UNDER 18 years of age (if under 18 years of age, please have a parent/legal guardian sign this release form)

4. If UNDER 18 years of age ~ I am the parent/legal guardian of the minor participating in the program.

5. Participant Email Address or Parent/Legal Guardian Email Address

6. Parent/Guardian Name

First Name

Last Name

7. Age of Minor

RELEASE: Photo, Video, and Audio: I understand that We R Listening, Inc. uses photo images, videos, and audio recordings on its website, social media, and in other types of media, such as brochures and flyers. I hereby grant permission to We “R” Listening Inc. and its agents and employees the irrevocable and unrestricted right to use, reuse, and publish the photographs, video images, and audio taken of me, or members of my family, for the purpose of publication, promotion, illustration, advertising, or trade, in any manner or in any medium. I hereby release We “R’ Listening Inc. and its legal representatives for all claims and liability relating to said images, video, or audio. Furthermore, I grant permission to use my statements that were given during an interview, guest lecture, workshop, or event with or without my name, for the purpose of advertising and publicity without restriction. I waive my right to any compensation.

8. I am 18 years of age or older, or the parent/legal guardian of the participant who is a minor, and I have read the foregoing and fully understand the contents thereof.

9. Date

YYYY

By submitting this form, I certify that I am the participant who is 18 years of age or older, or the parent/guardian of the participant who is a minor listed on this form, and my submission of this document serves as my e-signature.

ABOUT WE "R" LISTENING®

We R Listening Inc is a 501(c)(3) non-profit organization whose mission is to mentor and unlock the potential in every young girl we mentor. We accomplish this by building their confidence & self-esteem and help them to develop a positive perception of themselves so they can improve in their interpersonal relationships, excel in their academics, and make the best life decisions.

PHOTO/VIDEO/AUDIO RELEASE FORM

FOLLOW US:

ABOUT WE "R" LISTENING®

Contact Us:

Telephone: (347) 337-2926 Email: Info@werlistening.org