Gold Award Social Media Release Form

GSNorCal just started a new trend! We are going to be posting our Gold Awardees on social media! How do you get shown on GSNorCal’s social media pages? Just follow these steps!

  1. Earn your Gold Award with Coordinator Approval
  2. Fill out & submit this form
  3. Wait for a return email with your confirmation information! You should hear back from us with 10 business days.
  4. If you have any questions, please contact

Gold Awardee Information

I hereby grant to Girl Scouts of Northern California (“GSNorCal”) the irrevocable, royalty-free, perpetual, unlimited right and permission to use, distribute, publish, exhibit, digitize, broadcast, display, modify, create derivative works of, reproduce or otherwise exploit my name, picture, likeness and voice (including any video footage of the same, collectively, “Media”), for any purpose (except defamatory) including, without limitation, any use for educational, advertising, non-commercial or commercial purposes in any matter or media whatsoever (whether known or hereafter devised) including, without limitation, on the internet, in print campaigns, in-store and via television. I agree that I have no interest or ownership in any of the Media. I shall have no right of approval, no claim to compensation and no claim (including, without limitation, claims based upon invasion of privacy, defamation or right of publicity) arising out of the Use. I also hereby release and hold harmless GSNorCal from any claim for injury, compensation or negligence resulting or arising from any activities authorized by this Release.


Electronic Signature

I hereby give my consent for Girl Scouts of Northern California and its assigns or successors, to use the photo and information given in publications/media and whatever way they may desire, including audiovisual productions, including television and electronic transmission. Furthermore, I hereby consent that Girl Scouts of Northern California shall have the right to duplicate, reproduce, and make other uses of photographs and information give on this form for Girl Scout publicity and publications as they may desire free and clear of any claim whatsoever on my part. I am of legal age, and freely sign this release, which I have read and understand.

For minor girls (under 18 years old), your legal guardian must complete the electronic signature field below.

Published July 10th, 2017

* Please Note: Once you submit this form, you'll have the option to print the form contents on the following page.
Girl Scouting builds girls of courage, confidence and character that make the world a better place.  2014 Girl Scouts of Northern California