Media Consent and Release Form

For the purpose of promoting uCodeGirl's mission and activities, participants of uCodeGirl may be featured in materials to increase public awareness of our programs through newspapers, radio, TV, the internet, displays, brochures, and other types of media.

I, the undersigned, hereby give uCodeGirl and its authorized employees, and authorized media representatives permission to print, photograph, and record me for use in audio, video, film, or any electronic, digital and printed media.

a.     This is with the understanding that neither uCodeGirl nor its authorized representatives will reproduce said photograph, interview, or likeness for any commercial value or receive monetary gain for use of any reproduction/broadcast of said photograph or likeness. I am also fully aware that I will not receive monetary compensation for appearing in the promotional material.

b.     I further release and relieve uCodeGirl, its board, employees, and other representatives from any liabilities, known or unknown, arising out of the use of this material.

I certify that I have read the Media Consent and Release Liability statement and fully understand its terms and conditions.