Electronic Media Consent Form
Please read and fill out the form below.
I hereby give permission to Lakota Friends Circle to use: photographs, audio recordings, and visual recordings.
I hereby authorize Lakota Friends Circle to edit, alter, copy, exhibit, distribute and publish in print, video, audio recorded productions, and on the World Wide Web this material for purposes of publicizing Lakota Friends Circle programs or other lawful purpose without payment or any other consideration.
By signing this document, I understand that:
* The materials will be used only for nonprofit/educational purposes.
* Any proceeds from the sale of published or printed matter containing the materials will be used to support the mission of the above named nonprofit organization. (if applicable)
* The materials will become the property of Lakota Friends Circle, stored in a place chosen by Lakota Friends Circle and will not be returned to me.
In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. I waive any right to royalties or other compensation arising or related to the use of the materials. I hereby hold harmless and release and forever discharge the Lakota Friends Circle from all claims, demands, liability and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.
This authorization is continuous and may only be withdrawn by my specific rescission of this authorization. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.
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