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Camfed Release Form

The document is a participant release form granting CAMFED permission to use an individual's image, voice, name and information for reporting and communications. It releases CAMFED from legal claims and waives rights including copyright. A minor requires a parent/guardian signature agreeing to the provisions on their behalf.

Uploaded by

David Nkhoma
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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50 views2 pages

Camfed Release Form

The document is a participant release form granting CAMFED permission to use an individual's image, voice, name and information for reporting and communications. It releases CAMFED from legal claims and waives rights including copyright. A minor requires a parent/guardian signature agreeing to the provisions on their behalf.

Uploaded by

David Nkhoma
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PARTICIPANT RELEASE FORM

(NB: DFID-supported clients also to complete a DFID consent form)

School/Location and Country: _____________________________________________________________________________


Context of visit (e.g. partner visit/case study collection/filming):__________________________________________
Role of participant (e.g. student/CAMA/teacher/PSG member): __________________________________________
PLEASE USE THIS PSEUDONYM (in sensitive cases where real name not to be used): ___________________________

I irrevocably grant all consents and assign all rights (including copyright) exclusively to Camfed International and their respective
CAMFED Coalition partners, parents, affiliates, subsidiaries, licensees, successors and assigns (“CAMFED”) to record, photograph,
film, reproduce, exhibit, transmit, broadcast, commercially utilise, copy, distribute, publicly perform, publicly display, publish, and
otherwise use for all purposes, including but not limited to:
 Reporting and communication, including on the internet
 Inclusion on CAMFED’s website, newsletters, blogs and social media feeds
 Promotion of CAMFED’s mission, including fundraising
 Educational presentations and other audio-visual productions regarding CAMFED and its programs,
my image, likeness, voice, name, conversation, sounds, performance of any musical compositions, biographical material and
information (as may also be modified or edited by CAMFED as it deems fit), without time limit, worldwide, by all means, formats and
media (whether now known or hereinafter invented) without liability or acknowledgement to me as required under the Copyright,
Designs and Patents Act 1988 (the "Act") otherwise and hereby confirm that all moral rights under the Act or otherwise have been
waived. I acknowledge the personal value of the opportunity to participate in the Material, and I acknowledge the sufficiency of such
consideration.
I irrevocably release CAMFED from any known and unknown claims and damages of whatever kind or nature that may arise regarding
the use of the rights detailed above, including claims of defamation, invasion of privacy, infringement of moral rights, rights of publicity
and copyright, personal injury and all associated costs and fees. I understand that CAMFED is not obligated to use any of the rights
granted in this participant release and waive the right to inspect or approve the form or version of my image, likeness, voice, name
and information that may be used by CAMFED. I further represent that any statements made by me during my appearance are true
and they will not be defamatory, violate or infringe upon the rights of any third party.

Participant Name:_______________________________ Signature (if an adult*):____________________________________

Address:_________________________________________ SF CON #______________________________

Email:__________________________________________ Tel:__________________________
Date:_____________________

*If relating to a minor: I am a parent or guardian of the minor detailed above (or am acting in loco parentis with the guardian’s
consent) and consent and hereby agree that I and the said minor will be bound by all the provisions contained herein.

Guardian Name:________________________________ Signature:________________________________________________

Relationship to the minor: ________________________ Address:_________________________________________________

Email:_________________________________________ Tel:__________________________ Date:______________________

The following is required if this Participant Release has to be read or translated: I certify that I have read/translated (please delete as
appropriate) this Release in full to the individual whose name appears above, and that the individual has consented to the conditions of
this release.

Name:_________________________________________ Signature:________________________________________________

Role: __________________________________________ Address:_________________________________________________

Email:__________________________________________ Tel:__________________________ Date:______________________


CAMFED Participant Release Form 6/12/2018 - Page 1 of 2
PARTICIPANT RELEASE FORM (Continued)

Name of Participant: ___________________________ Salesforce CON#_________________

Signed on behalf of CAMFED *:

Name:_____________________________ Signature:___________________________________________

Role at CAMFED :_________________________ Office address:_________________________________________

Email:____________________________ Tel:___________________________Date: _________________

* To be signed by a National Director/member of the executive team

SUMMARY EXPLANATION OF PARTICIPANT RELEASE FORM

The accompanying PARTICIPANT RELEASE FORM gives CAMFED and others authorised by CAMFED permission to
use your image, voice, name and information for all purposes, including (but not limited to) reporting and
communications on the Internet.

 By signing the PARTICIPANT RELEASE FORM, you agree not to file lawsuits against and not to claim any
damages from CAMFED and others authorised by CAMFED for their use of your image, voice, name and
information.
 CAMFED and CAMFED partners may not need to use your image, voice, name and information. But if your
image, voice, name or information is used, CAMFED, and others authorised by CAMFED, do not need to ask for
your additional approval, or show you how your image, voice, name and information are used.

In accordance with CAMFED ’s Child Protection Policy, when publishing an image, voice, story or case study about
children under the age of 18 or vulnerable adults, CAMFED will:

 Not disclose the family name or the name of the school;


 Further protect identities where subjects have particularly sensitive stories to tell; and
 Exercise great sensitivity in the use of materials, respecting each subject's dignity and identity.

CAMFED Participant Release Form 6/12/2018 - Page 2 of 2

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