Media Release

I, for myself and for my minor child ("Participant") participating in the Kinney Program ("Program") of the Kinney Center for Autism Education and Support (the "Kinney Center") of Saint Joseph's University ("SJU"), and for my and Participant's heirs, agents and assigns (collectively, "Releasors"), for good and adequate consideration, the receipt and sufficiency of which are hereby acknowledged, hereby grant to Kinney Center and SJU, forever, exclusively, unconditionally and absolutely, all right, title and interest in and to all photography, audio and/or video or other media obtained by the Kinney Center or SJU that may include images or impressions of or from Participant's likeness, voice or otherwise (collectively, the "Media"), and further hereby release, waive and forever discharge SJU and Kinney Center, its and their present and former employees, shareholders, owners, directors, trustees, officers, officials, affiliates, insurers, licensees, subsidiaries, consultants, independent contractors, attorneys, representatives, successors and assigns, and their respective executors, heirs and administrators (collectively, the "Releasees") from all causes of action, liabilities, costs, attorney's fees and claims, in law or in equity, known or unknown, foreseen or unforeseen, accrued or unaccrued, future or contingent, that Releasors, or any of them, ever had, now has, may have or may claim to have in the future that arise out of or are related to Releasees' use, publication, distribution and/or sale of the Media. If I am part of a group, I represent to the Kinney Center and to SJU that I have the legal authority to bind the group to the terms of this Release. The Kinney Center and SJU shall retain at all times all right, title and interest in and to all Media.

During the course of Kinney Center events or activities opened to extended families and/or members of the general public, photographs, videos or other types of images of participants, including employees and clients of the Kinney Center may be obtained by those in attendance ("Images"). The capturing, publication or republication of these Images is beyond the control of the Kinney Center and/or Saint Joseph's University ("Publication"). Therefore, the University expressly waives any responsibility for the Publication of such Images and wishes those in attendance to be aware of this circumstance since it cannot control the creation of Images.

Participant's Name(s):

##1st Child First Name## ##1st Child Last Name##
##2nd Child First Name## ##2nd Child Last Name##
##3rd Child First Name ## ##3rd Child Last Name##