CONSENT FORM I have been informed about the truck count and air monitor project being created by Ironbound Community Corporation. I understand the purpose of this project is to track air pollution by truck count and air monitoring I understand that my story will be collected and used as media for this project. PERMISSION TO USE: PHOTOGRAPHS, VIDEO, AND AUDIO CONTRIBUTIONS I grant permission to Ironbound Community Corporation; and employees or appointed agents, to take photographs/digital images, video, and/or audio recording or quoted remarks of me, my minor child, and/or my property. I agree to my image, voice and likeness being used in promotional and educational materials. These materials might include video, printed or electronic publications, websites, blogs, social media or other electronic communications. I further agree that my name and identity may be revealed in descriptive text or commentary in connection with the materials. I acknowledge that any image(s) or recordings taken become the sole and exclusive property of Ironbound Community Corporation. I hereby irrevocably consent to the unlimited worldwide use by Ironbound Community Corporation, its subsidiaries, successors, and assigned contractors and third parties, of my name and all likenesses, photographs, videos, and reproductions of my face and/or body in any form, together with all accompanying sound recordings. I release Ironbound Community Corporation from any and all liability arising out of the use of my video reproductions, photographs and sound recordings, including without limitation any claims arising out of my right of privacy or right of publicity and any claims based on distortions or reproductions. I further acknowledge that my participation is voluntary and that I will not receive financial compensation of any type associated with the taking or publication of these materials. I__________________________ (name of parent/guardian), the undersigned parent/person having legal custody/guardianship give permission for the minor to participate with IRONBOUND COMMUNITY CORPORATION in the Environmental Justice Truck Count described above and all of the activities and trips associated with the program. I hereby grant full permission for _______________________ (name of youth) and/or myself to be photographed by IRONBOUND COMMUNITY CORPORATION or the Environmental Justice Truck Count, staff for any legitimate purpose without payment or compensation.My child(ren) is/are physically able and mentally prepared to participate in all activities as described in the description for the program. I hereby voluntarily and knowingly assume all risks and dangers inherent and incidental to the activities of the program. I will not hold IRONBOUND COMMUNITY CORPORATION liable for any injuries incurred during the program or while my child(ren) is/are in transit to and from the program or program trips whether caused by equipment or the act or omissions of others accepting damage or injury solely caused by the willful misconduct or negligence of IRONBOUND COMMUNITY CORPORATION or its employees, volunteers, or agents.I understand that the IRONBOUND COMMUNITY CORPORATION is not responsible for costs incurred for medical care. If I or my child(ren) participate in the program, whether as a participant, instructor, aide, or spectator, I presently waive as to IRONBOUND COMMUNITY CORPORATION staff, officers and directors thereof, any claim presently known or unknown for damage to property or personal injury whether caused by equipment or the acts or omissions of others including IRONBOUND COMMUNITY CORPORATION personnel.I HAVE READ AND UNDERSTAND THE ABOVE:
