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Please Read and Complete
As the parent/legal guardian of the below-named child, I give my permission for Providence Talks to obtain and use the following information for marketing communications and development purposes: photo and/or video of my child, written description of my child’s program or activities, and identification by name and town of residence. If there are any exceptions or stipulations in regards to the above permission given to Providence Talks and Federal Hill House, please describe below.
Providence Talks employees are authorized to use the information, as are individuals or entities and/or their agents working on Providence Talks projects including, but not limited to, Advocacy Solutions, Im-aj Communications & Design, Inc., Design Room, and Embolden Design Inc. to produce marketing communication materials exclusively for Providence Talks. The Information an/or photos/videos shall be used in a variety of Providence Talks marketing communications and development activities including, but not limited to, those listed below:
Annual reports, newsletter, brochures, media releases and/or coverage, mailings, web site postings, promotional materials and advertising for events.
These activities could result in either direct or indirect payment to Providence Talks. By giving authorization, it should be understood that upon disclosure, the potential to be re-disclosed by the recipient of the information is no longer under the control of Providence Talks or Federal Hill House.
By giving permission, I hereby release Providence Talks and Federal Hill House from any liability arising from the authorized use of this information by Providence Talks or its listed designee and indemnify Providence Talks for any claims arising therefrom.
By giving permission, I hereby authorize Providence Talks employees to contact me for a phone interview for the purpose of improving the overall quality of the program.
This authorization to use to disclose this information shall remain in effect until unless I revoke it in writing at any time by sending written notification to:
Assistant Director, Providence Talks, Roger Williams University, 1 Empire Plaza, Providence RI 02903
Promotional or educational materials and videos that use any of the below-listed information and are produced while this authorization is in effect can be used by Federal Hill House, Providence Talks and its agent for a period of six (6) years from the date of production. These materials and videos remain part of the agency’s historical record.