10,000 Degrees Image Informed Consent and Release Form
FOR STUDENTS UNDER 18 YEARS OLD + THEIR GUARDIANS
This form is intended for the use of obtaining permission to use images1 , testimonial and name. Why we are asking for your image & testimonial
● A picture speaks a thousand words! And when we share your story or testimonial, it’s even more impactful. As a nonprofit that relies on outside funding, 10,000 Degrees must share the work we do so that we may raise awareness and support from the broader, global community.
● To reflect the impact of 10,000 Degrees work through the people who’ve participated in our programs
● To educate our audiences and increase their understanding of our work
● To inspire audiences to support our work
How we will use your image & testimonial
● In multiple formats for our global audience (e.g., external communications - websites, videos, flyers, email, social media, presentation slides, impact reports, strategic plans, etc. and internal communications, etc.).
● Additional context may be added to enhance audiences’ understanding (e.g., we may include your name, 10,000 Degrees programs you attended, your high school/college, graduation year, career info, etc.)
● We strive to represent your likeness authentically.
Our global audience includes
● Our internal staff, board of directors, volunteers, and program participants (students, alumni, interns, etc.)
● Our external audiences, including:
○ Other organizations that work with us
○ Institutions, companies, and groups of individual donors who support our work by providing funding and other resources
○ Media including newspapers, magazines, TV, Instagram, Facebook, LinkedIn, etc.
○ All Salesforce database contacts, including students and audiences listed above
○ Students and families
Your Rights
● Sharing your image and testimonial is your decision.
● You have the right to change your mind at any time and revoke your consent. If you inform us in writing that you are revoking your consent, we will not use your personal image or testimonial in future communications. Please understand that we may not be able to withdraw images and stories already published.
1 For the purpose of this 10,000 Degrees permission form, an “image” is the representation of your likeness in the form of a photo(s), video(s), or illustration(s).
Permission and Release
By signing below, I give 10,000 Degrees permission to use my image, testimonial, and name as noted below, and I waive any right to royalties or other compensation related to the use of the photographs, video, or testimonial.
By signing below, I release and hold harmless 10,000 Degrees (including its officers, employees, board members, and agents) and any others who are involved in obtaining, using or publishing such images or testimonials from and against any claims or actions relating to arising out of the creation, use, distribution, reproduction or publication of any such photographs, video footage, or artistic renderings obtained by 10,000 Degrees.
I have read this document carefully and understand its contents.