I will hold harmless the Town of Washington, the After School Arts Program, Inc., the town of Woodbury, Woodbury Middle School and any of its agents, directors, employees, and supervisors for any responsibility or
liability for any injuries or property damage which may arise from my or my child’s participation in this
program. I understand that in the event of an injury, my own personal medical insurance will be used.
I authorize ASAP to record on video tape, photography, voice recording, or interview through print or
other media, my child’s first name, voice, image, artwork, and/or performance for informational
programs, reports and promotional materials to be used for noncommercial purposes.
I understand that neither my child nor I will receive compensation for this appearance and no private
individual will receive compensation of any kind as a result of broadcasting this material.