Media Release Form 2021

PHOTO/VIDEO/MEDIA RELEASE FORM (2023)

I ("I" or "Participant") hereby authorize SustainableScoop and those acting pursuant to its authority to: (i) record Participant's likeness and/or voice on a video, audio, photographic, digital, electronic or any other medium ("recording(s)"); (ii) edit, copy, and/or enhance the recording(s) for use in a final product and Participant waives the right to inspect or approve the finished product ("final product"); (iii) use Participant's name and biographical material in connection with such recordings and/or final products; (iv) use, reproduce, exhibit, and/or distribute my name, biographical material, and such recordings and/or final products in any medium (e.g., print publications, video, internet, etc for promotional, advertising, on websites or social medial sites and blogs, educational purposes, news (press), presentations, courses, and/or other lawful purposes and without any geographic restrictions. Participant releases and waives any claims or rights of compensation or ownership regarding such uses, recordings and/or final products and understand that all such recordings and/or final products shall remain the property of SustainableScoop. I certify that I am 18 years of age or older or that my parent/guardian has signed below.

Name of Participant

Participant Address

City

State

Zip Code

Participant Signature

Parent/Guardian Signature (if Participant is under 18 years of age)

Date

Phone number

Email

example@example.com

SustainableScoop Rep.

Notes

Participant's Role

Topic of Discussion (if applicable)

If you participated in an interview, what was the topic of the interview?