National Youth Storytelling Showcase Interview Release Form-Required

Interview Release Form - Required

(To be signed by the person being interviewed)

I,___________________________, am a participant in the City of Pigeon Forge Office of Special Events' storytelling program. I have agreed to share stories of my experiences in order that they are compiled into a uniquely and publicly presented oral story. I understand that the City of Pigeon Forge will retain a copy of the final story product as a part of a permanent collection that may be used for exhibit, publication, written or oral presentations and/or posted on the City's website in order that storytelling be shared across America. "National Youth Storytelling Showcase" is a component of the Celebrate Freedom™! event held annually, and the National Youth Storytelling Showcase is a component of the Smoky Mountains Storytelling Festival held annually.

Hereby grant permission to (insert interviewer's Name)__________________________ to utilize my life's story to create a unique storytelling presentation. By giving permission, I understand that I do not give up any copyright or performance rights that I may hold.

I also grant to the City of Pigeon Forge my full consent for the final story product to be used, published, presented and copied by the City of Pigeon Forge and its assignees in any medium.

I do hereby release the City of Pigeon Forge, its employees, agents, assignees, designees, from any and all claims and demands arising out of or in connection with the use of any part of my contribution to the final story product, including but not limited to, any claims for defamation, invasion of privacy, or right of publicity.

Accepted and Agreed:

Signature:_______________________________________ Date:_________________

Printed Name:__________________________________________________________

Signature of Parent or Guardian:____________________________Date:_________

Printed Name of Parent or Guardian:______________________________________

Address:_______________________________________________________________

City:__________________________State:_________Zip Code:__________________

Telephone: (____)_____________________________

Relationship to Interviewer:_______________________________________________