Media Release Form

Consent to Release Media

Teach RARE Media Consent Form

I hereby grant the Special Education Teaching and Learning Inc., its directors, officers, employees, agents, and designees (DBA “Teach RARE”) non-revocable permission to capture my image and likeness in videotapes, motion pictures, recordings, or any other media (collectively “Images”).

I acknowledge that Teach RARE will own such Images and further grant the Teach RARE permission to copyright, display, publish, distribute, use, modify, print and reprint such Images in any manner whatsoever related to Teach RARE organization, including without limitation, publications, advertisements, brochures, web site images, or other electronic displays and transmissions thereof. I further waive any right to inspect or approve the use of the Image by Teach RARE prior to its use. I forever release and hold the Teach RARE harmless from any and all liability arising out of the use of the Images in any manner or media whatsoever, and waive any and all claims and causes of action relating to use of the Images, including without limitation, claims for invasion of privacy rights or publicity.

I hereby warrant that I am eighteen (18) years old or more and competent to contract in my own name or, if I am less than eighteen years old, that my parent or guardian has signed this release form below. This release is binding on me and my heirs, assignees and personal representatives.
Please select all that apply.
I understand that my consent may be withdrawn after written confirmation sent to and include relevant details. The request may take up to 48 hours to complete.
Clear Signature
Skip to content