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Photo/Video Liability Waiver and Release

I, the undersigned, hereby authorize the Alameda County Safe Routes to Schools (SR2S) Program and its administering agency, the Alameda County Transportation Commission (Alameda CTC), the right to use any photograph(s) and/or video footage of myself and/or my minor child participating in any and all Alameda County Safe Routes to Schools Program activities. Such photograph(s) and/or video footage may be used in program communications, publications and other media, including their websites and social media accounts, for SR2S Program purposes including, but not limited to, SR2S Program promotion and marketing, editorial publication, and non-commercial promotional use and advertising.

On behalf of myself and my child, I hereby waive and release all rights to financial compensation for use of such photograph(s) and/or video footage, and all rights to inspect or approve the uses of such images and likenesses. The authorizations and release I make in this agreement are made in perpetuity. I release Alameda CTC from any claims for remunerations associated with any form of damage, foreseen or unforeseen, associated with the commercial or artistic use of such photograph(s) or video footage. 

I hereby certify that I am the parent or guardian of the child named below, and that I have read, understood, and agreed to the foregoing. 


Today's Date: December 15, 2025


The Alameda County Safe Routes to Schools Program is a program of the Alameda County Transportation Commission (alamedactc.org) and is funded with Alameda County’s local Measure BB sales tax, and regional, state, and federal funds

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

School Name *
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Information

School Name *
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Information

School Name *
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Information

School Name *
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Information

School Name *
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Information

School Name *
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Information

School Name *
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Information

School Name *
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Information

School Name *
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Information

School Name *
Parent or Guardian's Email Address

Email*

Confirm Email*
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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*

Last Name*

Phone*
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 Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

School Name *
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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