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I hereby give my consent for the Building Blocks 2 Success – BB2S LEGO Robotics Program, to use my photograph and likeness for the lawful purpose, including for example such purposes as publicity, illustration, advertising and Web content. I hold harmless and release them from any expectation of confidentiality for the undersigned minor children and myself and attest that I am the parent or legal guardian of the children listed below.

Any photos, recorded (audio or video) and written materials created for and/or during BB2S LEGO Robotics Program are the property of Building Blocks 2 Success and may be used for promotional purposes at the discretion of Building Blocks 2 Success.

This release is effective until revoked in writing by the undersigned. Such revocation shall only be effective to prevent any expanded future use of the records.

Building Blocks 2 Success is a registered 501(c)3 Non-Profit Corporation (EIN: 46-4014410). For inquiries, or to donate time or resources please contact:

Antonio Jackson
Co-Founder & Executive Director
Building Blocks 2 Success
(971) 301-2227
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Mailing Address:
PO Box 13441
Portalnd, OR 97213

© 2019 Building Blocks 2 Success, All Rights Reserved
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