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About
Our Story
The LYS Experience
The Team
Pine Ridge Reservation
Contact
Get Involved
For Hosts
What’s Involved
What You Give
What You Get
F.A.Q.
Apply to Be a Host
For Youth
What’s Involved
What You Give
What You Get
F.A.Q.
Apply to Lakota Youthstay
Supplemental Application Information
Volunteer
Volunteer Trips!
Volunteer Trip Testimonials
Volunteer for the Advisory Team
News/Events
Reflections on LYS
Photo Gallery
Support Us
Donate
Gratitude
Stay Connected with Us!
Subscribe to Our Newsletter!
Facebook
Instagram
Photographs and Video Consent, Waiver, Indemnity and Release
Youthstay Applicant's Full Legal Name
First
Middle
Last
Parent/Legal Guardian's Name
First
Last
Email
Phone
Photographs, Videos and Recordings
I hereby grant permission to One Spirit and the Lakota YouthStay program and all its representatives to take photographs or videos of my child and to make recordings of my child’s voice at any One Spirit, Lakota YouthStay or host family event or any location associated with One Spirit or the Lakota YouthStay program. I further grant to One Spirit and the Lakota YouthStay program and their representatives the right to reproduce, use, exhibit, display, broadcast, distribute, and create derivative works of these images and recordings in any media now known or later developed to promote the Lakota YouthStay program to others anywhere and at any time including for fundraising purposes. I acknowledge that One Spirit and the Lakota YouthStay program owns all rights to the images and recordings.
Waiver, Indemnity and Release
I hereby waive any right to inspect or approve the use of the images or recordings or of any written copy. I further waive all moral rights. I also waive any right to royalties or other compensation arising from or related to the use of the images, recordings, or materials. I hereby release, defend, indemnify and hold harmless One Spirit and the Lakota YouthStay program and all its representatives including directors, members, volunteers, committee/advisory members and interested parties from and against any claims, damages or liability arising from or related to the use of the images, recordings or materials, including but not limited to claims of defamation, invasion of privacy, or rights of publicity or copyright infringement, or any misuse, distortion, blurring, alteration, optical illusion or use in composite form that may occur or be produced in taking, processing, reduction or production of the finished product, its publication or distribution. I have read this document before signing below, and I fully understand the contents, meaning and impact of this consent, waiver, indemnity and release. This consent, waiver, indemnity and release is binding on me, my family, my heirs, executors, administrators and assigns.
Parent/Legal Guardian's Signature
Date Signed
MM slash DD slash YYYY