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MEDIA RELEASE FORM


I, as a community member/customer or student participating in a Whalefall event or activity, hereby authorize Whalefall, and its affiliates, Immerse Gear, LLC, dba GIVES Research Lab, Blue Endeavors, members and representatives (each or any combination thereof that may be referred to as, or conversely so, "Whalefall"), a nonexclusive grant to:


(a) Record my likeness and voice on video, audio, photographic, digital, electronic, online or on any other media/social media format (collectively “Recording(s)”).


(b) Use my name in connection with these Recordings.


(c) Use, reproduce, publish, republish, exhibit, edit, modify, or distribute, in whole or in part, these Recordings, in all media, without compensation, for any purpose that Whalefall deems appropriate and consistent with the Whalefall mission, including educational, social media marketing, and training. These Recordings may appear in a variety of formats and media now available from Whalefall and that may be available in the future otherwise (e.g. print publications, video productions, tapes, Internet, mobile, digital etc.).

Accordingly, I hereby release Whalefall, from any liability, or debt, to me personally, for such use of the Recordings. I understand that all Recordings, in whatever medium, shall be, and will remain the property of Whalefall, and that Whalefall shall only use such Recordings to further the Whalefall mission.

I have read and understand the terms of limited release. 

PARTICIPANT SIGNATURE: 

Date: February 23, 2025




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First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Address
Address Line 1:
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:
City:
State/Province:
Zip/Postal:
Parent or Guardian's Email Address

Email*

Confirm Email*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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