Project Title: Dates of recording: Location: Individual Minor Participation Release: Last First (Child’s Name) My child participated in the above project, which I understand will be produced and recorded for duplication and broadcast. I agree insofar as I am concerned, this project may be edited as desired and used in whole or in part for broadcasting purposes and all other non-broadcast purposes in any manner or media, in perpetuity throughout the world. I consent to publication of the project in whole or in part after broadcast and also consent to use of my likeness and voice, in connection with project publicity and for institutional promotional purposes. I expressly release KRCB (Rural California Broadcasting Corporation), its licensees and assignees, from any privacy, defamation, or other claims I may have arising out of broadcast, exhibition, publication, or promotion of this project. Signed (Parent’s Signature) Date Address (please print) City State Zip Phone KRCB 5850 Labath Avenue Rohnert Park, CA 94928-2041 707 585-8522 Fax 707 585-1363
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