Attachment J-2 - Fieldworker - Release Form.docx

ATTACHMENT J-2 – 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:

Fieldworker

I am a fieldworker or field supervisor participating in the COVID 19 American History program, an initiative to generate contemporary collections about cultural activity and traditions from the community perspective.

By signing and submitting this form, I hereby grant 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 recording(s), images, and other forms of documentation (collectively, “Documentation”) generated by the interview that I am submitting herewith, but only to the extent of my rights in the Documentation.

This permission is limited to the use of the Documentation for archival purposes (such as preservation and service to the public) and the non-commercial projects of the Library of Congress.

This permission authorizes use of the Documentation on the Library’s Website, on third party Websites, and in/on all existing and future forms of media.

I hereby release and discharge the Library of Congress from 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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