MEDIA RELEASE FORM (the "Release")

For good and valuable consideration, including without limitation any goodwill and publicity that I may receive from the publication of the Recordings (as defined below), the receipt and sufficiency of which I hereby acknowledge, I agree as follows:

CONSENT. I hereby authorize and irrevocably grant Children’s Defense Fund and its employees, affiliates, licensees, agents, and assignees (collectively, "CDF”), the perpetual, irrevocable, fully paid-up, royalty-free, worldwide, unrestricted right to create, modify, distribute, publish, display, perform, prepare derivatives of, and otherwise use any videos, recordings, photographs, and other documentation, in any media or format, now known or hereafter created (the “Recordings") that feature or depict (a) my name, image, likeness, voice, signature, biographical information, personal characteristics, and other elements of my identity or persona (collectively, my "Likeness") and/or (b) any of my statements in writing or otherwise that relate to CDF and its products or services (my "Stories"). Pursuant to the foregoing, CDF shall have the perpetual and irrevocable right and license to use my Likeness and/or Stories in the Recordings and all other materials that CDF shall create, in any media or format, including without limitation for distribution in print, publications, exhibitions, public displays, editorials, or via television, radio, or the Internet, for the advertising, marketing, publicity and promotion of CDF and its products, services and for CDF’s other business purposes (collectively, "Promotional Materials"). I hereby waive any inspection or approval of any kind over my Likeness as photographed, videoed or otherwise recorded by CDF, or any use thereof in the Recordings and Promotional Materials. I acknowledge that (a) CDF has no obligation to use my Likeness and (b) I am not receiving any financial compensation for the consents, releases and rights granted hereunder or otherwise in connection with CDF’s use or reuse of my Likeness.

OWNERSHIP. I acknowledge that CDF shall exclusively own all right, title and interest in and to all intellectual property in and to the Recordings and other Promotional Materials throughout the world, and I irrevocably transfer and assign to CDF all right, title, and interest that I may have in the same; including any moral

I represent that I am the parent or legal guardian of the minor child named below. I have read and understand the contents of the Release, and I understand and agree that it is binding on me, the minor child and our heirs, assigns and personal representatives.

MENTOR CONSENT

I , authorize my scholar to participate in RFDC Mentor Program, Food for Thought. Your Scholar will meet with An RFDC mentor during their identified school lunch periods. The mentor will focus on helping scholars with social, emotional, and academic health. This can include helping with schoolwork, help with interacting better with peers. Mentors will meet with your scholar consistently every week. Mentors will be contacting you after every visit as well as communicating regularly with teachers, school administrators, therapists, and any other identified individuals needs for your scholar. Our goal is to support scholars grow in different capacities while also nurturing them to be their best versions of themselves.

PERMISSION FOR PHOTO/FILMING/MEDIA

The Roberts Family Development Center takes photographs and films of its participants and uses the images for publicity on the center’s website, Facebook, newsletter, and other forms of social media and outreach. Roberts Family Development Center does not compensate children or families for the use of the images/ film.

FIELD TRIP PERMISSION

I give permission for my child (above stated students) to participate in all of the field trips that are coordinated by the after-school program from the Roberts Family Development Center. In case of emergency, I authorize my child to receive medical treatment. I understand that I will be notified in advance regarding any field trip that my child is invited to attend.

WALK HOME AUTHORIZATION FORM

I hereby request the Roberts Family Development Center staff release my child(ren) from the program at dismissal time to walk home. The Roberts Family Development Center Program will not release any child(ren) any other time without written authorization from a parent, for any reason.

Waiver: I authorize my child to walk home and acknowledge the program will not assume any responsibility or liability once my child has left the facility. I hereby grant permission for my child to leave the program and walk home without the guidance of an authorized adult, contrary to program policy. I understand and agree that Roberts Family Development Center, a nonprofit organization, will not assume responsibility for my child who has left the facility. I discharge the Roberts Family Development Center, a nonprofit organization, its officers, agents, and employees, from any lawsuits, damages, claims, or judgments resulting from any personal injuries or property damages that my child/ward may sustain once he/she has left the program and/or facility, thereby indicating to program staff that he/she is no longer participating in an activity sponsored by the Roberts Family Development Center.

PARENT COMMITMENT AND PLEDGE

I , promise to make a positive contribution to the Roberts Family Development Center. I promise to take the necessary actions that will ensure my child’s success in school and in life.

My household will commit to making my child’s school academic career a priority. I will also participate in the following while my child attends the Roberts Family Development Center after-school program:

• I will attend ALL monthly parent meetings.
• I will attend all assigned volunteer field trips that I have signed and agreed to attend.
• I will attend as many extracurricular activities/events as possible with my child.
• I will make sure my child attends the after-school/ Freedom Schools program daily.