2022 YLC Staff Info & PR Agreement Form If you have any questions about this form please email [email protected] with subject header "YLC Staff Completed Info & PR Form". Deadline: May 1, 2022 Name * Required First Last Hometown (City, State) * Required Current status * RequiredUndergrad studentGraduate studentEmployedOtherOther * Required What did you study or are studying in College? * Required Occupation * RequiredNote: You can list "student" if you are a current college student. Hobbies * RequiredEx.: Hiking, fishing, and reading books. Favorite Quote * Required Headshot * Required Drop files here or Select files Max. file size: 300 MB. Please submit a photo of yourself for the camp newsletter.Please be ADVISED that the information above will be published in the NAD YLC newsletter and NAD YLC web page for the campers/parents to read before going to YLC.Email * Required Text number * RequiredMay we share your e-mail/text with other NAD YLC staff members? * RequiredYesNoMeal Preference * RequiredRegularVegetarianVeganGluten-FreeGluten-Free VegetarianGluten-Free VeganOther (Please list under special needs/diet or allergies)Special needs/diet or allergiesPlease tell us if you have any unique talent/experience to share with the campers. Ex: You biked across America. Upload here if you have a current Oregon Food Handlers’ Certificate Drop files here or Select files Accepted file types: pdf, doc, docx, jpg, gif, png, jpeg, Max. file size: 300 MB. Upload here if you have a current CPR Certificate Drop files here or Select files Accepted file types: pdf, doc, docx, jpg, jpeg, gif, png, Max. file size: 300 MB. Upload any other certificates (ie., water safety) that you feel would be useful to YLC Drop files here or Select files Accepted file types: jpg, gif, png, pdf, doc, docx, jpeg, Max. file size: 300 MB. Publicity Release: I hereby consent, authorize, and assign all rights to the National Association of the Deaf (NAD) organization, its agents, officers, employees, and all others to whom release or circulation may be made including news and media organization to use, reproduce, distribute, exhibit, or broadcast photos, videos, film, and audio recordings of myself and/or projects, for use in publicity releases and program marketing. I further consent and authorize the National Association of the Deaf (NAD) to release or circulate the same in any manner for any and all purposes in any form with or without my name. I understand the photos, videos, and/or film may be viewed by the general public and that other uses may be made of them. I further agree and consent that the NAD and the others authorized herein are not responsible for any misappropriation of the photos, videos, and/or film by any member of the general public or anyone else. I have read the foregoing release, authorization, and agreement before signing below and I declare that I fully understand the contents of this document.Signature * RequiredImage and Video DescriptionWhile this section is optional, we highly encourage you to let us know as this will help us write our image and video description accurately. Your image description: how would you like us to identify you (i.e. white woman wearing eye-glasses and brown hair) Pronouns (i.e. he, she, ze, they)