The Minerva Education and Development Foundation needs participant/student and/or parent permission to use a person’s photograph, voice, and/or name in media projects. Please review the information below, check the appropriate box, and sign and date the form where indicated.

I hereby grant MEDF or its designee permission to photograph, videotape, and/or interview me and/or my minor child and to reproduce my name or that of my child. I understand that any photographs, movies, video recordings, audio recordings, presentations, interviews, and other media content will become the property of MEDF and that MEDF may use this media content for public view. I also hereby consent and grant MEDF the right to edit, copyright, exhibit, publish, and use these images and recordings products for non-profit purposes, including use in articles and other print materials, on the Internet, and in all other forms of media. I understand that media content may be used by MEDF for educational, instructional, or promotional purposes in broadcast and electronic formats that currently exist or that may be created in the future.

I understand that I and/or my organization will not receive any compensation, and I waive any further reimbursement regardless of the number of times the appearance, image, or voice is used or rebroadcast. I hereby release MEDF and its employees, agents, or designees from all claims, demands, and liabilities whatsoever in connection with or arising from the use of said media content (e.g., photos, videos, audio clips, etc.).