Attachment J-1 - Interviewee Release Form.docx

ATTACHMENT J-1 – 030ADV23R0048

COLLECTION AFC NUMBER:

THE LIBRARY OF CONGRESS

101 INDEPENDENCE AVENUE, S.E. WASHINGTON, D.C. 20540-4610

COVID 19 American History Program Permission and Release Form: Interviewee/Participant

I agree to participate in cultural documentation connected to the COVID 19 American History program, an initiative to generate contemporary collections about cultural activity and traditions from the community perspective.

I hereby grant the field worker the right to record, photograph, and otherwise document my participation.

I understand that the recording(s), images, and other forms of documentation (collectively, “Documentation”) of this interview will be deposited in the permanent collections of the Library of Congress’s American Folklife Center, where it will be made available to researchers and other library patrons under the existing copyright laws and regulations of the Library of Congress. In addition, copies may be retained by the interviewer and/or the local organization participating in the COVID 19 American History program.

To the extent of my rights in the Documentation, I hereby grant to the Library of Congress the perpetual, nonexclusive, transferable, worldwide right to use, reproduce, transmit, display, perform, prepare derivative works from, distribute, and authorize the redistribution of the Documentation. This permission is limited to use of the Documentation for archival purposes (such as preservation and service to the public) and for non‐commercial projects of the Library of Congress. This permission authorizes use of the Documentation on the Library’s Web site, on third party Web sites, and in/on all existing and future forms of media.

I hereby release and discharge the Library of Congress from any and all liability arising out of any injury of any kind which I or my associates may sustain from participation in this COVID 19 American History project.

I warrant that I have the full right, power, and authority to grant this permission and release.

Signature: Date:

Print Name:

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