Student Release Form

TCP Media Release Form_General

I give THE CHALLENGE PROGRAM, INC. and people acting for and with THE CHALLENGE PROGRAM, INC. permission to communicate with me by email, phone, or virtual platforms (i.e., Microsoft Teams, Zoom, etc.) and to video/audio record me for an interview, meeting, and/or marketing (print, social media, digital) for educational, promotional, and marketing purposes. I will make no monetary or other claims in connection with the authorized use of my name or photos, video, interviews, and quotes. I release THE CHALLENGE PROGRAM, INC. and their employees, and partner organizations from any claims, demands, and liabilities in connection with the items listed below, authorized and agreed to here by me.

Photographs or video footage of me.
Written or Recorded interviews of me, including quotes made by me.
Provide a photo of myself if requested.
My full name and school in connection with the photographs, video footage, interviews, quotes, or community service.

I agree to the above statement

Name of Student*

First

Last

Date*

Age*

Email address of Student.*

Name of High School*

If under the age of 18, you must have a parent/guardian fill out the rest of the form.
If over 18, please write in "I am 18 years of age or older."

Parent/Guardian First and Last Name*

Email address of Parent/Guardian

Please type the characters*

This helps us prevent spam, thank you.

This field should be left blank

TCP Media Release Form_General

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