Staff Info & Public Release Form

2025 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, 2025
Name * Required
First Last
Hometown (City, State) * Required
Current status * Required
Other * Required
What did you study or are studying in College? * Required
Occupation * Required
Note: You can list “student” if you are a current college student.
Hobbies * Required
Please choose your top three hobbies. Ex: Hiking, fishing, and reading books.
Favorite Quote * Required
Headshot * Required
Drop files here or

Max. file size: 300 MB.
Your photo will be used 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 * Required
May we share your e-mail/text with other NAD YLC staff members? * Required
Meal Preference * Required
Special needs/diet or allergies
Please 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

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

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

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 * Required
Image and Video Description
While 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)