NCAS-M II Likeness and Profile Release to NOAA Consent StatementI, hereby, grant to the U.S. Department of Commerce, National Oceanic and Atmospheric Administration (NOAA) the irrevocable, lifetime, royalty free, non-exclusive, worldwide right to use my [or the below-listed minor’s] name, image, likeness, portrait, or voice (hereinafter “Likeness”), as specified below, in all forms, in all manners, and in all media now existing or to be created in the future, as part of the activities of the NOAA Cooperative Science Center in Atmospheric Sciences & Meteorology (NCAS-M) II. The intended use of these materials is for communication, outreach, and education products. I understand that NOAA may also assign, with the same rights, my [or the below-listed minor’s] Likeness to the below-listed Partner organization(s) for these intended uses. I also grant to NOAA the irrevocable right to use biographical information provided from and about me [or the below-listed minor’s] in all forms, in all manners, and in all media now existing or to be created in the future, as part of the below-referenced activities. Further, I waive any right to inspect or approve my [or the below-listed minor’s] Likeness or Profile in the finished version in which I or my [or the below-listed minor’s] organization appear and/or incorporating the Likeness(es), including written copy that may be created and appear in connection therewith. NOAA may, if deemed practicable, grant requests for me to access, for my reference and not for my inspection or approval, a draft version of the product in which my Likeness appears. I hereby waive any claims I may have based on any usage of any video, photographs, or works derived there from, including but not limited to claims for invasion of privacy or publicity or for libel. I further release and absolve NOAA from any liability resulting from any use of my [or the below-listed minor’s] Likeness or Profile. It is expressly agreed, however, that NOAA is under no obligation to use said Likeness or Profile for any purpose whatsoever. Moreover, I understand that NOAA will not compensate me in any way or pay me for use of my [or the below-listed minor’s] Likeness or Profile. I hereby warrant that I have sole copyright ownership of any written copy, photograph(s), video, film footage, audio, and/or any information presented by me or provided to NOAA, or that I have obtained permission from the copyright owner(s). Further, I agree to indemnify NOAA in the event that it suffers liability or damages as a result of its use of any written copy, photograph(s), video, film footage, and/or any information referenced in this paragraph. If 18 or older: I further warrant that I am 18 or older, no parental or guardian consent is required, and that I have every right to contract in my own name in the above regard. I further state that I have read this Release and that I am fully familiar with and understand the contents thereof. I agree that this shall be binding on me, my legal representatives, heirs, and assigns. Privacy Act Statement Authority: The collection of this information is authorized under 5 U.S.C. 301(Departmental regulations), 5 USC 552a (Records maintained on individuals); 15 U.S.C. 1512 (Powers and duties of Department), 44 U.S.C. 2904 (General responsibilities for records management) and NOAA’s programmatic authorities. Purpose: Individual’s permission is required for use of photographs, video, and audio in any format, used for communication, outreach, and education products. NOAA must not collect any personal information from children under the age of 13, unless parental permission is provided in writing. Routine Uses: The information is used for the purpose set forth above and may be used consistent with the published routine uses as identified in the Privacy Act System of Records Notice DEPT-18, Employees Personnel Files Not Covered by Notices of Other Agencies and NOAA-11, Contact Information for Members of the Public Requesting or Providing Information Related to NOAA’s Mission. Further, this information may be forwarded to another NOAA or non-NOAA user social media account; shared with other Federal Agencies, scholarly research educational facilities, news organizations, disaster relief organizations, and partners. Photographs, videos, and audio recordings may be shared—for governmental purposes—externally and displayed on NOAA websites and social media platforms and as part of physical displays/exhibits. Disclosure: VOLUNTARY. Furnishing this information is voluntary; if permission is not given, then the photographs, videos, or audio recordings will not be used. Federal employees are advised that failure to provide this information will not adversely affect their employment or possibility of promotion. I agree to the NCAS-M II Likeness and Profile Release to NOAA.Name(Required)if signing this Release on behalf of a minor, the parent or legal guardian should state the minor’s name here. First Last Signature(Required)Signature Date(Required) MM slash DD slash YYYY Institution(Required)SelectHoward UniversityJackson State UniversityPennsylvania State UniversitySan Jose State UniversityUniversity at Albany – State University of New YorkUniversity of Maryland Baltimore CountyUniversity of Maryland College ParkUniversity of Puerto Rico MayaguezUniversity of Texas El PasoPhone(Required)Email(Required) Date(s) of Activity Photographed/Filmed/Recorded, etc. (if known): MM slash DD slash YYYY Location(s) of Activity Photographed/Filmed/Recorded, etc. (if known): Brief Description of image(s)/video(s)/audio(s) used (if known):Partner organization(s) (if applicable)