LIKENESS AND PROFILE

RELEASE TO NOAA

I,________________________________________[if signing this Release on behalf of a minor,

the parent or legal guardian should state the minor’s name here:

_______________________________________] hereby, grant to the U.S. Department of

Commerce, National Oceanic and Atmospheric Administration (NOAA) the irrevocable,

lifetime, royalty free, non-exclusive, worldwide right to use my [or the above-listed minor’s]

name, image, likeness, portrait, or voice (hereinafter “Likeness”), as specified below, in all

forms, in all manners, and in all media now existing or to be created in the future, as part of the

activities of the NOAA Planet Stewards Program

Date(s) of Activity Photographed/Filmed/Recorded, etc.(if known):_______________________

Location(s) of Activity Photographed/Filmed/Recorded, etc. (if known):

______________________________________________________________________________

Brief Description of image(s)/video(s)/audio(s) used (if known):

_____________________________________________________________________________

Partner organization(s) (if applicable) (herinafter "Partner(s)"):

_____________________________________________________________________________

The intended use of these materials is for communication, outreach, and education products. I

understand that NOAA may also assign, with the same rights, my [or the above-listed minor's]

Likeness to the above-listed Partner(s) for these intended uses.

I also grant to NOAA the irrevocable right to use biographical information provided from and

about me [or the above-listed minor’s] in all forms, in all manners, and in all media now

existing or to be created in the future, as part of the above-referenced activities.

Further, I waive any right to inspect or approve my [or the above-listed minor’s] Likeness or

Profile in the finished version in which I or my [or the above-listed minor’s] organization appear

and/or incorporating the Likeness(es), including written copy that may be created and appear in

connection therewith. NOAA may, if deemed practicable, grant requests for me to access, for

my reference and not for my inspection or approval, a draft version of the product in which my

Likeness appears. I hereby waive any claims I may have based on any usage of any video,

photographs, or works derived there from, including but not limited to claims for invasion of

privacy or publicity or for libel.

I further release and absolve NOAA from any liability resulting from any use of my [or the

above-listed minor’s] Likeness or Profile. It is expressly agreed, however, that NOAA is under

no obligation to use said Likeness or Profile for any purpose whatsoever. Moreover, I

understand that NOAA will not compensate me in any way or pay me for use of my [or the

above-listed minor’s] Likeness or Profile.
I hereby warrant that I have sole copyright ownership of any written copy, photograph(s),

video, film footage, audio, and/or any information presented by me or provided to NOAA, or

that I have obtained permission from the copyright owner(s). Further, I agree to indemnify

NOAA in the event that it suffers liability or damages as a result of its use of any written

copy, photograph(s), video, film footage, and/or any information referenced in this paragraph.

If 18 or older:

I further warrant that I am 18 or older, no parental or guardian consent is required, and that I

have every right to contract in my own name in the above regard. I further state that I have

read this Release and that I am fully familiar with and understand the contents thereof. I

agree that this shall be binding on me, my legal representatives, heirs, and assigns.

Signature: Date:

Printed Name:

Affiliation (if applicable):

Position (if applicable):

Phone (_____) _____________ E-mail: ___________________________________________

If representative of minor:

Parental Consent: I am the parent or legal guardian of the minor named above. I have the legal

right to consent to and do consent to the terms and conditions of this release on behalf of the

minor named above.

Parent/Guardian Signature: Date:

Printed Name:

Phone (_____) _____________ E-mail: ___________________________________________

Privacy Act Statement

Authority: The collection of this information is authorized under 5 U.S.C. 301(Departmental

regulations), 5 USC 552a (Records maintained on individuals); 15 U.S.C. 1512 (Powers and

duties of Department), 44 U.S.C. 2904 (General responsibilities for records management) and

NOAA’s programmatic authorities.

Purpose: Individual’s permission is required for use of photographs, video, and audio in any

format, used for communication, outreach, and education products. NOAA must not collect any

personal information from children under the age of 13, unless parental permission is provided

in writing.

Routine Uses: The information is used for the purpose set forth above and may be used

consistent with the published routine uses as identified in the Privacy Act System of Records

Notice DEPT-18, Employees Personnel Files Not Covered by Notices of Other Agencies and

NOAA-11, Contact Information for Members of the Public Requesting or Providing

Information Related to NOAA's Mission.

Further, this information may be forwarded to another NOAA or non-NOAA user social media

account; shared with other Federal Agencies, scholarly research educational facilities, news
organizations, disaster relief organizations, and partners. Photographs, videos, and audio

recordings may be shared—for governmental purposes—externally and displayed on NOAA

websites and social media platforms and as part of physical displays/exhibits.

Disclosure: VOLUNTARY. Furnishing this information is voluntary; if permission is not

given, then the photographs, videos, or audio recordings will not be used. Federal employees are

advised that failure to provide this information will not adversely affect their employment or

possibility of promotion.