THC General Media Release Authorization

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This form is intended for individuals asked to fill out a Media Release Authorization. This form ensures that individuals whose image and work is being distributed from our platforms are providing permission for The Haven Community to publish content that belongs to/portrays them. Please read this form in entirety and sign as stated. 

The Haven Community is run completely online. Please be aware of your digital footprint and safety on the internet as you contribute your work directly to us. 

The Haven Community requests your permission to reproduce through printed, audio, visual, or electronic means for the purpose of releasing content via our sites or platforms. Your authorization will enable us to use specially prepared materials to increase public awareness and promote continuation and improvement of community involvement, mental health awareness, personal anecdotes, etc.

Please be aware that we will only publish work that you contribute directly to our organization, whether through Engage (Staff Management System), E-Mail, Text, Hard Copy, etc.

If you have any questions regarding the safety of this media release policy, please address your concerns to The Haven Community administration at [email protected]. 

Please enter your full name as it appears on the Staff Management System.
Format: First Last
Example: Johnathan Appleseed
Please use your personal e-mail (Gmail, Outlook, etc.). Please DO NOT enter your @thehavencommunity.net or @department.thehavencommunity.net e-mail in this section. 
Please enter your THCnetID only if you were assigned one through hire/volunteer initation. If you are a professional staff, your THCnetID is in the format XX### (where XX is your initials and ### is a randomly assigned three digit code). If you are a contractor, volunteer, or other community member, your THCnetID is the string directly before "@department.thehavencommunity.net" in your UPN. Your THCnetID most likely includes your first initial, last name, and possibly a number.

Your THCnetID is an address at The Haven Community that ties your identification. If you need to recover your THCnetID, please login to Engage@THC and click on your profile. Your THCnetID will be displayed under User Details → Public Domain THCnetID.
Please note that you may only waive the Parent Authorization Requirement if you are 18 years of age or older. Upon waiving the requirement, our Leadership Department is subject to verify the authenticity of your age.

To the Minor's Parent: 

As a parent signing this Media Release Authorization, you agree to the following:

I, as a parent or guardian, of the above named pupil fully authorize and grant The Haven Community and its leadership department the right to print, photograph, record, and edit as desired, the biographical information, name and image of the above named pupil on any electronic and printed formats, currently developed for the purposes stated or related to the above. These information will be only published on The Haven Community's platforms. 

I understand and agree that use of such Recordings will be without any compensation to the student volunteer or the student volunteer's parent or guardian.

I understand and agree that The Haven Community and/or its leadership department shall have the exclusive right, title, and interest, including copyright, in the published information.

I understand that the works will be published under the above pupil's name for all work contributed and turned in from their account, which is then collected via internal systems at The Haven Community, including Engage at The Haven Community and 365. 

I hereby release and hold harmless The Haven Community and its leadership department from any and all actions, claims, or expenses, including attorney’s fees, brought by the pupil and/or parent or guardian which relate to or arise out of any use of these publications as specified above.

My signature shows that I have read and understand the release and I agree to accept its provisions.

*Please note: if you have any questions about this authorization or its contents, please e-mail us at [email protected].

As a contributor signing this Media Release Authorization, you agree to the following:

I fully authorize and grant The Haven Community and its leadership department the right to print, photograph, record, and edit as desired, the biographical information, name and image of myself on any electronic and printed formats, currently developed for the purposes stated or related to the above. These information will be only published on The Haven Community's platforms. 

I understand and agree that use of such Recordings will be without any compensation to myself.

I understand and agree that The Haven Community and/or its leadership department shall have the exclusive right, title, and interest, including copyright, in the published information.

I understand that the works will be published under my name for all work contributed and turned in from their account, which is then collected via internal systems at The Haven Community, including Engage at The Haven Community and 365.

I hereby release and hold harmless The Haven Community and its leadership department from any and all actions, claims, or expenses, including attorney’s fees, brought by myself which relate to or arise out of any use of these publications as specified above.

My signature shows that I have read and understand the release and I agree to accept its provisions.

*Please note: if you have any questions about this authorization or its contents, please e-mail us at [email protected].

Sign above