Thank you for your interest in joining a dialogue session. Please fill out the form, and we will email you the details.Dialogue Interest Form Date Name * Name First First Last LastParent/Guardian: Parent/Guardian: First First Last Last Email * Phone Is there a specific topic that interest you? Consent to be recorded: * Yes NoFor valuable consideration received, I (you) model (photoshoot & recording participant) hereby grant to (Denver Journal of Education and Community) the absolute and irrevocable right and unrestricted permission to use, re-use, display, distribute, transmit, publish, re-publish, copy, or otherwise used (as it pertains to this project), either in whole or in part, either digitally, in print, or in any other medium now or hereafter known, for any purpose whatsoever and without restriction, images are taken of me, or in which I may be included; to alter the same without restriction in perpetuity and to copyright the same. I understand and agree that the Photographer may or may not use my name in conjunction with the images as he or she so chooses. I hereby release and discharge the Denver Journal of Education and Community, and his or her agents, representatives, and assignees from any and all claims and demands arising out of or in connection with the use of the photographs or film/video footage, including without limitation any and all claims for invasion of privacy, right of publicity, and defamation. I represent that I am over the age of eighteen (18) years and that I have read the foregoing and fully understand its contents. This release shall be binding upon me, my heirs, legal representatives, and assigns. This agreement is being made and entered into under the laws of the State of Colorado and shall be governed and interpreted in accordance with the laws of said state. This agreement embodies the entire agreement of the parties (model “Photo Shoot Participant” and Denver Journal of Education and Community). No modification of this agreement shall be of any effect unless it is made in writing and signed by all of the parties to the agreement. Do you have any dietary restrictions? reCAPTCHA If you are human, leave this field blank. Submit