I, parent or guardian of the above named candidate, hereby waive all claims against the Shades of Kulture dba World Ebony Network (WEN), and any other personnel involved in any injury or accident while participating in this program. I also grant permission to managing personnel or other representatives to authorize and obtain medical care should the above participant becomes ill or injured when neither parent or guardian is available to grant authorization for emergency treatment. I also certify that all information on this form is true and that misrepresentation could result in suspension from the program.

I, hereby grant to Shades of Ebony Kulture dba World Ebony Network (WEN) their successors, and their assignees the right to record the image and/or voice and use the artwork and/ or written work of my child or (I, as an adult), on videotape, on film, on photographs, in digital media and in any other form of electronic or print medium and to edit such recording at their discretion.

I understand that my child’s or (my, as an adult) full name, address and biographical information will not be made public. I further grant Shades of Ebony Kulture dba World Ebony Network (WEN), their successors, and their assignees the right to use, and to allow others to use, my child’s image and/or voice on the internet, in brochures, and in any other medium and hereby consent to such use.

I hereby release Shades of Ebony Kulture dba World Ebony Network (WEN), their successors, and their assignees and any using my child’s or (me, as an adult) image and/or voice, artwork, and/or written work pursuant to this media release form any and all claims, damages, liabilities, costs and expenses which I or my child now have or may hereafter have by reason of any use thereof.