employU creates a variety of multimedia marketing pieces in an effort to amplify messaging related to its services to a broader audience and thereby increase the amount of people benefitted by the program. In order to be featured in our marketing materials, we are required to obtain consent of all participants. Please read through the consent form, and if you agree to all terms, sign and date.

Any person under the age of 18 who participate in employU marketing efforts must have a parent or guardian signed authorization. If you appear as a representative of a business, please indicate the name of the business on the appropriate line on the form. If you are not an employU client or business partner, please select Community Member as the relationship to employU field.

Please select how you best relate to employU from the list below.

1. By signing below on this date, I, {participantFirst} (the "Participant") give consent to be interviewed, photographed, filmed or video/audio-taped, and/or having my voice, image or other likeness recorded by employU, Inc., or any employees, volunteers or agents that it may engage for the purposes of publicizing, promoting, marketing or advertising employU, Inc.'s activities, programs and services.

2. I grant employU, Inc. permission to use and/or disclose any writing or other expression in any tangible medium created by me in connection with employU, Inc.'s activities, programs and services (collectively, "Works"), as well as any interviews, photographs, films, video/audio tapes and other recordings of me ("Depictions") in employU, Inc.'s publications or in any other broadcast, print or electronic media, including but not limited to brochures, mailings, newspaper, radio, television, magazines, or the internet. I further grant permission for employU, Inc. to edit any such Works or Depictions and incorporate them into any compilation or derivative work as is deemed necessary or appropriate. I understand that these depictions may be used and distributed without any further authorization or notice to me.

3. I understand that I may be identified by name. I also understand that employU, Inc is a nonprofit disability employment service and that in publicizing, promoting, marketing or advertising its activities, programs and services, any disability or disabilities that I have may be publicly disclosed. I further understand that once information about me is in the possession of the media or members of the general public, employU, Inc. does not retain control over its editing or use.

4. I understand that will not receive any compensation, intellectual property right, title or license, or other payment for the use and/or disclosure of the Works or the Depictions for the purposes described above.

5. I hereby release employU, Inc. and its board members, officers, employees, volunteers and agents, from any and all claims, liability, and damages, which might arise from the use and/or disclosure of the Works or the Depictions for the purposes described above.

I specifically acknowledge that I personally have read and agree to the above paragraphs. I UNDERSTAND THAT I AM PERMANENTLY GIVING UP SUBSTANTIAL RIGHTS including but not limited to my right, and the right of my legal representatives, to sue.