Sponsored by : University of Virginia - QuestionPro Academic Sponsorship Programme
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Exit Survey
 
 
Dear Parent,

Youth-Nex at the University of Virginia is creating an archive of video stories about youth capability. We want to highlight the positive contributions that youth are making every day. Whether it is getting physically fit, creating positive situations in their life, volunteering in the community or building great relationships, we want to hear about it. The goal is to create a resource for other adolescents to reference when they want advice or want to hear about how someone their own age dealt with an issue…or to be inspired by another adolescent's passion about a specific topic.

We are hosting a video contest where kids between the ages of 15 and 21 can submit their videos to us for a chance to win $100. Those videos will be posted on the youthSPEAK website (ynyouthspeak.wordpress.com) as a resource for other kids. If you are okay with your child participating in this contest, please read and electronically sign the media transfer form below.


I hereby grant the University of Virginia the right and permission to use these submitted photographs, audio and/or video materials (“Recorded Materials”) of my child listed below to the University of Virginia. I hereby grant the University the right and permission to use the Recorded Materials for teaching, learning, or promotional purposes, in University print or web publications, posting to the World Wide Web, or to third party sites such as YouTube at the University’s sole discretion in conjunction with the Youth-SPEAK project.

I represent and warrant that I own the Recorded Materials or have obtained a lawful right to authorize the University to exercise the above-authorized uses by the lawful owner of the Recorded Materials. I represent and warrant that any content (images, sounds, or recordings of other persons) that I have incorporated in the Recorded Materials has been used with permission and will not infringe the rights of any person or entity.

I waive any right to compensation arising from or related to the University’s use of the Recorded Materials for the purposes specified above. I understand that the copy I provide of Recorded Materials in whatever medium shall become the property of the University. I acknowledge the University's right to crop, edit, or otherwise adapt the Recorded Materials in its sole discretion. I also acknowledge that the University may choose not to use the Recorded Materials at this time, but may do so at a later date, consistent with the purposes specified above.

I hereby agree to release and hold harmless the Rector and Visitors of University of Virginia, its officers, employees and agents, from any claims, damages or liability arising from or related to the above-authorized uses of the Recorded Materials.

I state that I am the parent, guardian, or otherwise legally authorized adult capable of giving consent on behalf of the minor child named below.
 
I agree to the terms stated above and certify that the information provided on this form is correct.
 
I do not agree to the terms stated above.