Salt Lake Teens Write
Publicity Release for
Teens
I understand that while my child is involved in the Salt Lake Teens Write program there may be
written materials published, photographs taken, voice recordings made, or other records made of
my child's image or likeness, including the publication of my child's name, for the purpose of
promoting or publicizing the program and/ or disseminating work prepared for the program. Some or
all of these materials may be published on paper, on the Salt Lake City Public Library or SLCC
Community Writing Center websites, or through other forms of electronic media.
i expressly permit my child's writing, image, likeness and/ or name to be used in connection with
publicizing or promoting the Salt Lake Teens Write mentoring program and/ or disseminating any
work prepared by my child.
I further understand that neither I nor my child shall be entitled to any compensation or anything of
value in connection with the use or dissemination of my child's writing, image, likeness or name.
I release and discharge the Salt Lake City Public Library and the SLCC Community Writing Center
from any and all claims and demands arising out of or in connection with the use of the writing,
image, likeness or name of my child, including any and all claims of libel.
Please sign and return this form to the SLCC Community Writing Center (210 East 400 South. Ste.
8, Salt Lake City, UT 84111) or email to cwc@slcc.edu
Parent/ Guardian Name & Relationship to
T
een Teen's Name
Signature Date
Witness Signature Date
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