Safety Town Parental / Gardian Release Form

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* 1. Volunteer's Name:

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* 2. Parents Name:

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* 3. Parents Phone #:

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* 4. PARTICIPANT’S RELEASE

I hereby give my consent for the above student to be a volunteer at Safety Town.
I also give my consent for him/her to accompany the class on field trips and will not hold the St. Joseph Safety and Health Council responsible in case of accident or injury whether it be en route to or from Safety Town.
I hereby agree to hold the St. Joseph Safety and Health Council, its employees, agents, representatives, and volunteers harmless from any and all liability, actions, causes of action, debts, claims, or demands of every kind and nature whatsoever which may arise by or in connection with participation by my child/ward in any activities related to the Safety Town program.

If I cannot be reached and in the event of any emergency, I also give consent for the St. Joseph Safety and Health Council to obtain through a physician or hospital of its choice, such medical care as is reasonably necessary for the welfare of the child if he/she is injured in the course of Safety Town activities.

PHOTO/VIDEO RELEASE

Photos/ video are taken by staff members and media sources while your student is attending Safety Town. Pictures may be used in advertising, on the Council’s website/FACEBOOK pages, United Way media material, news articles, etc.

YES,
I grant full permission to the St. Joseph Safety and Health Council to use any photograph, slide, film or any other record of this event in public relations materials and allow third parties to use such public relations materials for their promotional purposes. The usage may include printed materials, billboards, video, miscellaneous media or internet projects. I waive all rights to compensation for this use.

NO,
I do not grant permission.

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* 5. St. Joseph Safety Council has been awarded the one by one® Grant from 4imprint!

We were excited to utilize the funds to purchase items for your student(s) that will be attending Safety Town. To show our appreciation, we would like to send pictured of their product in use. Below is a Photo Release from 4Imprint. You are not at all obligated to participate in this release, also know that Safety Council will NOT release your child(s) name to 4imprint at any time.

One by one (4imprint)
Photo Release
I hereby give 4imprint® permission to publish or republish any photographs in which I am pictured (or in which a minor who I am parent or guardian to is pictured):
1. On the one by one website, on 4imprint website(s), and promotional materials for one by one content/program including press releases, emails, social media, catalogs and flyers.
2. To use my (or my child’s) name and/or organization name, if applicable.
3. To include the photo(s)/name(s) provided as part of 4imprint’s copyrighted one by one materials and promotions.
4. To use the name of the city or place where the photograph was taken, if 4imprint so chooses.

I hereby waive my right to inspect or approve the one by one materials in which the photograph(s) is published.

I agree to release 4imprint from any and all claims arising out of the use of the photograph(s). In
addition, 4imprint agrees to indemnify the person photographed if any third-party claims arise for the organization out of 4imprint’s use of the photograph in one by one materials.

Yes