Media Release Form

    Alaska Mountaineer Youth Development & Sports Program

           Alaska Mountaineer Youth Development & Sports Program volunteers and members of the media, may ask to interview,
    videotape and/or photograph your student-athlete or non-athlete.  These images and interview content received, may be posted
    on the Alaska Mountaineer Youth Development & Sports Program website or in local and national media.

           Please indicate your agreement for your child to be photographed, interviewed or videotaped by completing the form below.  
    This form also gives permission for such photographs, videotape and information to be posted on national websites such as the
    Amateur Athletes Union (AAU) and Youth Basketball Of America (YBOA), etc.  Such permission granted below will remain in
    effect until revoked, in a written document, delivered to the Alaska Mountaineer Youth Development Program.

                                           ALASKA MOUNTAINEER YOUTH DEVELOPMENT & SPORTS RELEASE FORM

            I DO hereby give permission to the Alaska Mountaineer Youth Development & Sports Program, and news media, to
    photograph, and videotape my child.  It is my understanding that the photographs, video, and interview information received, may
    be used for public viewing.

    I agree to allow my child to participate in these activities, and for the resulting materials to be used, without financial
    remuneration, and I understand that this form completely releases the Alaska Mountaineer Youth Development & Sports Program
    from any and all liability, claims or demands for remuneration or damages, arising from the use of said materials.

            I DO NOT grant permission to photograph, videotape, or to post information on the Web about my child.




    Student/Athlete: ________________________________________________________

    Print Name: ___________________________________________________________

    Signature of Parent/Guardian: _____________________________________________

    Date: ____________