Tel. 907.586.1432 www.ccthita-nsn.gov Toll Free 800.344.1432
Media Consent
I, the undersigned authorize the Central Council of the Tlingit and Haida Indian Tribes of
Alaska (Tlingit & Haida) to use (display, publish, and/or distribute) my name, picture,
portrait, likeness, or voice in any publication, media production, display, advertisement or
digital/online material, without limitation as to time.
I understand that the photographs, audio recordings, negatives and/or video footage, if
used, will be for informational or educational purposes of Tlingit & Haida and I waive any
right to inspect or approve the finished photos, print, and/or advertising copy. All
photographs, audio recordings, negatives, and/or video files shall constitute the sole
property of Tlingit & Haida. I declare that I am of legal age and have every right to contract
in my own name in the above regard.
I, the undersigned hereby waive all rights or claims for compensation in connection with the
use of my name, picture, portrait, likeness, or voice in any publication, media production,
display, advertisement or digital/online material, without limitation as to time; in whole or in
edited form and any use to which the same or any material therein may be put, applied or
adapted by Tlingit & Haida. In signing this waiver I acknowledge that Tlingit & Haida, its
agents, officers, and employees are released from any and all claims and demands arising
out of or in connection with the use of said photographs/images, including but not limited to,
any claims for invasion of privacy or defamation.
Accepted and Agreed:
Child’s/Children’s Name(s):
___________________________________________
Signature (Parent/Legal Guardian Signature) Date
___________________________________________
Printed Name Date
Tlingit and Haida Indian Tribes of Alaska
Office of the President • Edward K. Thomas Building
9097 Glacier Highway • Juneau, Alaska 99801
