Photo & Video Release Waiver

Mock Document – For Website Demonstration Purposes Only

1. Grant of Permission

I hereby grant to Path to Unity ("PTU"), its representatives, employees, volunteers, affiliates,
successors, and assigns, the irrevocable right and permission to photograph, video record, and/or
otherwise capture my image, likeness, voice, and statements during PTU events, programs,
interviews, and related activities.

2. Use of Materials

I authorize PTU to use, reproduce, edit, distribute, publish, display, and publicly perform the
recorded materials in any format or media now known or later developed, including but not limited
to website content, social media platforms, promotional materials, advertising campaigns, printed
publications, and broadcast or streaming media.

3. No Compensation

I acknowledge that I will receive no financial compensation or other remuneration for the use of my
image, likeness, or voice.

4. Waiver of Rights

I waive any right to inspect or approve the finished product or any written or digital copy that may be
created in connection with the materials. I release and discharge Path to Unity from any claims,
demands, or causes of action arising out of or related to the use of such materials.

5. Voluntary Participation

I acknowledge that my participation is voluntary and that I am at least 18 years of age. If signing on
behalf of a minor, I affirm that I am the parent or legal guardian of the minor named below.

Participant Information

Full Name:
Date: Date
Email (Optional):


If Participant is Under 18:
Minor’s Name:
Parent/Guardian Name:
Parent/Guardian Signature: _________________________________
Date: August 12, 2026