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Authorization to Release Photographs, Videos, and Voice Recordings

I, (Parent or Legal Guardian) residing at , , , , hereby authorize Children’s Assistive Technology Service (hereinafter referred to as "C.A.T.S.") to take and/or obtain and use photographs, videos, and voice recordings of my child, , and to disclose the following personal information:

Description of Material: The material may include, but is not limited to, photographs, audio recordings, and video footage (collectively referred to as “Material”).

Purpose: The Material will be used for purposes that include, but are not limited to, educational, promotional, publicity, fundraising, and awareness of C.A.T.S. and its programs, activities, and mission.

Scope: This permission extends to the use of the Material in any media format including print, television, radio, digital, or any other form of media now known or to be developed in the future, and may be used on C.A.T.S.’s website, social media accounts, newsletters, press releases, displays, brochures, and any other promotional or public materials.

Expiration: This authorization is in force until December 31, 2026 , unless earlier rescinded in writing.

Not a Condition for Receiving Equipment: Providing this authorization is voluntary and not a condition for receiving equipment or services from C.A.T.S.

Rights: I understand that the Material will become the property of C.A.T.S., and I release and discharge C.A.T.S. from any claims and demands arising out of or in connection with the use of the Material, including, without limitation, any claims for libel or invasion of privacy.

Release of Liability: I understand that I will not receive any compensation for the use of the Material, and hereby release C.A.T.S. and its agents, representatives, employees, and any third parties acting under C.A.T.S.’s authority from liability for any violation of any personal or proprietary right I may have in connection with such use.

Revocation: I may withdraw (revoke) this Authorization in writing at any time by sending a written notice of revocation to the C.A.T.S. Privacy Officer at the following address:

12801 Moneta Road

Moneta, VA 24121

Withdrawal of this Authorization does not affect any disclosure of personal information or release of Material made before the receipt of written notice of revocation by the Privacy Officer.

Acknowledgment: I have read this Authorization to Release Photographs, Videos, and Voice Recordings and fully understand its contents. I confirm that I am the parent with legal custody or the legal guardian of the above-named child and have the legal authority to execute this release.

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August 6, 2024 1:44 am EDT

Authorization to Release Photographs, Videos, and Voice Recordings Uploaded by CATS Administration - info@atdevicesforkids.org IP 98.166.151.97

August 6, 2024 2:00 am EDT

Timp Hecht - timp@atdevicesforkids.org added by CATS Administration - info@atdevicesforkids.org as a CC'd Recipient Ip: 98.166.151.97