Educational Grants
Renewal Application

I certify that the information contained in this application is true, correct and complete to the best of my knowledge and that I understand and will honor the scholarship eligibility requirements. If awarded a scholarship I will maintain a minimum GPA of 3.0. I understand the college/university will advise Bellevue LifeSpring if I become ineligible by reason of grades or being placed on disciplinary probation.

Participant, and the parents or legal guardians of the Child and any Participant who is under the age of 18 (a minor), are signing this Publicity Authorization ("Authorization") to bind themselves, their minor children, their heirs, successors, assigns and estates to the conditions described herein. Participant understands and agrees that the grant may result in publicity. Participant authorizes Bellevue LifeSpring to publicize the grant and to use Participant's name, photo, likenesses and other information about Participant and the grant, whether embodied in photographs, videotapes, recordings or any other format (collectively, "Information"), for purposes of promotion, publication, commercial advertising, or any other purpose whatsoever, now or at any time in the future. Participant understands and agrees that Bellevue LifeSpring may use any such Information: (1) in all manner and media whatsoever, whether now known or hereafter invented, including electronic and print media and the Internet; (2) with or without Participant's name; (3) without the payment of royalties or other compensation to anyone; and (4) without the need to notify them or to seek further approval before doing so. I agree that any picture, portrait, or other depiction of the Participant provided to Bellevue LifeSpring and any other picture, portrait, or other depiction of the Participant created by or given to Bellevue LifeSpring from any Bellevue LifeSpring event or activity, including the acceptance or award of the grant, is owned by Bellevue LifeSpring and may be copyrighted in Bellevue LifeSpring's name. If I should receive any print, negative or other copy thereof, I shall not use it or authorize its use by anyone else for a commercial purpose. I hereby waive any right to inspect or approve of any usage of the Information described above. Further, I hereby release and discharge Bellevue LifeSpring from any and all claims arising out of or under this Authorization, including, but not limited to, any claims for blurring, distortion, optical illusion or alteration or any claims for failure of Bellevue LifeSpring to use the Information. I understand and agree that I will not be monetarily compensated for consenting to this use of the Information. I also understand and agree that Bellevue LifeSpring has no duty to use the Information. I warrant and represent that (a) I have the full right and authority to enter into this Authorization; (b) I have not granted anyone else the exclusive right to use the Information; and (c) Bellevue LifeSpring's use of the Information shall not infringe or violate the rights of any third party. I hereby release and hold harmless Bellevue LifeSpring from and against any and all liability arising out of the exercise of the rights granted by this Authorization. Participant acknowledges reading and understanding this Authorization. For any minor Participant, the signature of their parent or guardian is on behalf of the parent/guardian and on behalf of the minor. Participant agrees that this Authorization fully and accurately expresses their understanding and has not been modified orally or in writing.