I consent to be videotaped, photographed and interviewed while participating in a Playworks activity. I agree that this program material may be edited as desired, duplicated and used in whole or in part throughout the United States and abroad. I consent to the use of my name, likeness, voice, and biographical material for program publicity and institutional promotional purposes (including, but not limited to newspaper articles with photos, press releases for Playworks web and online promotion, events, promotional videos representing the organization, photos for archival records and documentation for funders).
By providing the requested information and by signing this form, I expressly release Playworks, its licensees and assignees, from any claims I may otherwise have arising out of broadcast, exhibition, publication or promotion of this program material.