Rhode Island PBS Foundation Appearance Consent and Release Form
RequiredRequired Question(s)
I, the undersigned, do hereby grant, assign and convey to the WSBE Rhode Island PBS/Rhode Island PBS Foundation ("Rhode Island PBS"), its licensees and assigns, all rights worldwide in perpetuity to my performance made in or as a result of my participation in the Your Year 2020 Rhode Island High School Graduation Special ("Project"). I acknowledge and agree that the audio, visual recordings and photographic images of the Project ("Video Recordings") shall be the sole and exclusive property of Rhode Island PBS and shall be works made for hire to the extent permitted by law. Where any such Video Recordings do not qualify as works made for hire, I hereby assign or grant to Rhode Island PBS a worldwide, exclusive right in and to such materials. Rhode Island PBS shall exclusively own all of the rights in and to such Video Recordings throughout the world for any purpose and I shall have no rights in such materials.
 
I consent to publication, demonstration, distribution or broadcast of the Video Recordings in whole or in part, in any and all media worldwide, and expressly waive any and all rights of privacy, attribution and integrity I may have in connection with such Video Recordings. I agree that the Video Recordings or portions thereof may be edited by or on behalf of Rhode Island PBS at Rhode Island PBS's discretion, and used in whole or in part by or on behalf of Rhode Island PBS, its licensees or assigns, in any manner or media for any purpose. I hereby waive any right that I may have to review or approve the final, edited version of my performance and its use, and assign to Rhode Island PBS all right, title, and interest in and to any video or audio tape, film, negatives, prints, stills, or promotional materials made in connection with the Project.
 
I hereby release, discharge and agree to hold harmless Rhode Island PBS, its licensees and assigns, from any liability (including reasonable attorneys' fees) including, without limitation, liability for libel, defamation, invasion of any right of privacy or publicity arising out of the use of the Project, the Video Recordings, or any portion thereof. I understand that I may be taped individually or with a group during this Project. I also understand that involvement in the Project does not guarantee that my likeness and voice will appear in the Video Recordings.
 
Required
I acknowledge I have read, understand, and agree with this Consent and Release form.
YES * Please note: Unless you say "YES" and submit this Consent and Release form, we cannot use your video.
No
Required
If the Project participant is a minor, a parent or legal guardian must give consent.

As the parent or legal guardian of the minor child in the Project, I acknowledge I have read, understand, and agree with this Consent and Release form.

Yes
The participant is not a minor.
Required
Please complete all of the following information.

First Name:
Last Name:
Home Phone:
Email Address:
emailaddress@xyz.com
City:
High School Name:

Please provide Minor Child's First Name and Last NameĀ 

 

50 characters left.
Required

Date Submitted

 

50 characters left.