I, {name}, hereby grant permission as the legal parent/guardian of {studentsName} to participate in the Cape Assist and Cape May County Healthy Community Coalition’s Public Service Announcement Contest. I understand, and consent to my child’s name, photo, age, grade, attending school, likeness, appearance, image, voice, video, and artwork may be used for promotional, advertising, and educational material, including but not limited to print, digital, direct mail, and for use on the internet for an indefinite duration. In addition, I understand that any other student present in the submitted PSA must complete and submit a consent form.

I grant additional permission to Cape Assist and Cape May County Healthy Community Coalition that any information or materials submitted may be altered as they see fit. I waive any right to approve the final product. In addition, the student and student’s legal parent/guardian agree to indemnify and hold harmless Cape Assist and Cape May County Healthy Community Coalition, its officers, employees, and agents from and against any claims, actions, costs, judgments, or damages of any type relating to the production or distribution of the materials submitted during the contest.

I acknowledge that I will not receive any compensation other than the prize(s) set forth by the contest if my submission is selected.

For any questions and/or comments, please email Natalia at natalia@capeassist.org.