I, __________, grant to Aprendamos Intervention Team, PA, (Aprendamos Intervention Team, Esperanza Children's Therapy, Mariposa Autism Service Center, Alegria Family Counseling, Cariño Home Visiting Program, and Unidos Fathering Services) including its authorized employees, agents and representatives, and its affiliates, the perpetual and irrevocable right and permission to use and publicly display my and/or family's name, likeness, voice, words (audible or written) and/or property (individually or collectively, my "Likeness") alone or with those of others, by means of photographs, video, images, audio recording, and/or written statements taken or made of my and/or my family's Likeness in any format or media, and to adapt, modify, reproduce, distribute, publicly perform, display and/or copyright such photographs, video, images, audio recording, and/or written statements, in whole or in part, individually or in conjunction with other materials, in any media now known or later developed, and for use in any commercial or lawful business purpose related to Aprendamos Intervention Team, PA, including, without limitation, in advertising, promotional, public relations, educational and fundraising materials.

I agree that the photographs, video, images, audio recording, written statements and likeness of myself and family become the property of Aprendamos Intervention Team, PA and may not be returned to me. I understand that I will not have any rights of ownership to such photographs, video, images, audio recording, written statements, and likeness. I also understand that Aprendamos Intervention Team, PA shall own all rights to such photographs, video, images, audio recording, written statements, and likeness, and I waive my and/or my family's right to inspect or approve their use by Aprendamos Intervention Team, PA. I understand that I am not entitled to any compensation or royalty for use of the photos, video, images, audio recording, and/or written statements taken of myself or my family. I understand that my and/or my family's Likeness may not necessarily be used by virtue of this agreement.

I agree to join the Aprendamos Intervention Team, PA electronic mailing list and to receive outreach emails from Aprendamos. I understand that Aprendamos will never share or sell my email address. If at anytime you would like to revoke your consent please contact your program director or the Director of Community Relations at info@aitkids.com.