Hyde Square Task Force Media Release Form (ENG)

Thank you for being part of our programs! Below is a media release form. If the participant will be part of more than one session (summer, fall, winter, or spring), you will have the opportunity to complete a new media release form each session. This will provide the opportunity to change your response if needed. Your response to this form will be effective as of the date it is submitted. How you respond on this form does not impact your eligibility for HSTF programs.

Participant Information

Participant First Name

Participant Last Name

Participant Email

Is the participant 18 years or older? If yes, a parent/guardian signature is not needed.

Media Release Consent

Photo/Video Consent and Release - 17 years or younger (parent/guardian should complete): I hereby give permission for Hyde Square Task Force to use for educational and/or publicity purposes only any photographs, film, or video taken of my child during the course of his or her participation in Hyde Square Task Force programming. I understand that my child and/or any other identifying information may be used in accounts of Hyde Square Task Force programs, including newspaper and magazine articles, social media, website and other internet materials, television, and other presentations or publications concerning the programs. I understand and acknowledge that my consent to the use of the above information is purely voluntary and is not required by Hyde Square Task Force as a condition of my child’s participation in Hyde Square Task Force programming. I knowingly and voluntarily release and hold harmless Hyde Square Task Force, its agents and employees from any liability of any kind resulting from use of the information as set forth above. This release and waiver of liability is binding upon my successors, heirs, and assigns.

You have my consent.You DO NOT have my consent.

Photo/Video Consent and Release - 18 years or older: I hereby give permission for Hyde Square Task Force to use for educational and/or publicity purposes only any photographs, film, or video taken of me during the course of my participation in Hyde Square Task Force programming. I understand that I and/or any other identifying information may be used in accounts of Hyde Square Task Force programs, including newspaper and magazine articles, social media, website and other internet materials, television, and other presentations or publications concerning the programs. I understand and acknowledge that my consent to the use of the above information is purely voluntary and is not required by Hyde Square Task Force as a condition of my participation in Hyde Square Task Force programming. I knowingly and voluntarily release and hold harmless Hyde Square Task Force, its agents and employees from any liability of any kind resulting from use of the information as set forth above. This release and waiver of liability is binding upon my successors, heirs, and assigns.

You have my consent.You DO NOT have my consent.

Participant Signature

Parent/Guardian Signature

Today's Date

Contact Information