I hereby certify that I am an adult or that I am the adult parent or guardian of the Minor Child identified below. I, for myself, or on behalf of the Minor Child and on behalf of my heirs, assigns, and personal representatives, hereby irrevocably grant and license full permission to The Community Foundation of Greater Johnstown, Inc. t/a Community Foundation for the Alleghenies, by any means, whether now known or hereinafter developed, to exhibit, edit, alter, copy, record, reproduce, broadcast, transmit, publish, distribute, perform, use and reuse in connection with the publicity for the fund, in any manner, without further notification, authorization or compensation to me or to the Minor Child, mine or the Minor Child’s name and likeness in any photographs, video tapes, motion pictures, recordings, or other digital media (Photos), in any and all media, whether known or unknown or hereinafter developed, worldwide and in perpetuity. I understand and agree that the Photos and responses to the “New Fund Publicity Form” will become the property of The Community Foundation of Greater Johnstown, Inc. t/a Community Foundation for the Alleghenies, and Photos will not be returned. I or on behalf of the Minor Child hereby hold harmless, release, and forever discharge The Community Foundation of Greater Johnstown, Inc. t/a Community Foundation for the Alleghenies, from all claims, demands, and causes of action which I, my heirs, assigns, and personal representatives have or may have by reason of this Authorization. I agree to the Photo & Information Authorization

I agree to complete the Authorization by electronic means. I agree that the laws of the Commonwealth of Pennsylvania will apply concerning the Authorization.

I HAVE READ AND UNDERSTAND THE ABOVE PHOTO AND INFORMATION AUTHORIZATION. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE. IF I AM UNDER 18 YEARS OF AGE, MY PARENT/GUARDIAN HAS READ AND UNDERSTAND THE ABOVE PHOTO AND INFORMATION AUTHORIZATION

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