Operator: Counter Culture US, Inc., a Delaware corporation, doing business as Keens Academy (“Keens Academy,” “Keens,” “we,” “us,” or “our”)
Address: 2035 Sunset Lake Road, Suite B-2, Newark, Delaware, United States
This Optional Media and Marketing Consent (“Media Consent”) is separate from the Safety Waiver, Privacy Policy, Children’s Privacy Notice, and consent needed to submit a recording for assessment. An assessment submission is used for evaluation and related service operations only unless this separate Media Consent is completed.
1. Voluntary Choice
Giving this Media Consent is optional. Refusing or withdrawing it will not prevent the participant from accessing the core Keens Academy Services, classes, assessments, or feedback.
The participant or parent may select only the uses they approve. A blank or unchecked option means that use is not authorized.
2. Media Covered
This consent applies only to the specific content identified below (“Approved Media”):
Participant Name: _
Account Email or ID: __
Description of Approved Media: _
Recording / File / Assessment Reference: ___
Date Created or Submitted: ___
It does not apply automatically to future recordings, unrelated assessments, private messages, health information, parent communications, or other account data.
3. Approved Elements
Select each element that may be used:
☐ Participant’s image or likeness
☐ Participant’s voice
☐ Participant’s performance
☐ Participant’s first name only
☐ Participant’s full name
☐ Participant’s stage name or username
☐ Written quote or testimonial identified below
☐ Assessment score, level, or progress result identified below
☐ Other: _
No sensitive personal information, home address, school, private contact information, health information, or unapproved information may be included.
4. Approved Purposes
Select each approved purpose:
☐ Keens Academy website and service pages
☐ Keens Academy organic social-media posts
☐ Keens Academy paid digital advertising
☐ Keens Academy presentations, pitch materials, or partner materials
☐ Keens Academy printed promotional materials
☐ Press, public-relations, or media outreach by Keens Academy
☐ Internal staff or instructor training that is not public
☐ Other specific purpose: _
Use for AI model training, biometric identification, sale to data brokers, unrelated third-party advertising, merchandise, or political advocacy is not authorized by this Media Consent.
5. Editing and Presentation
For the approved purposes, Keens Academy may make reasonable technical and editorial changes to the Approved Media, such as cropping, resizing, captioning, translating, color correction, sound adjustment, excerpting, and combining it with approved branding or other materials.
Keens Academy will not knowingly use editing to materially misrepresent the participant, fabricate an endorsement, place the participant in a harmful or degrading context, or disclose information not authorized above.
6. Channels, Territory, and Term
Approved Channels or Accounts: _
Territory:
☐ Worldwide, because approved online channels may be accessible globally
☐ Limited to: _
Consent Term:
☐ Three years from the signature date
☐ Until the following date:
☐ One campaign or use described here: _
No new marketing use may begin after the term ends unless a new consent is obtained.
7. License for Approved Uses
For the selected purposes, elements, territory, channels, and term, the participant—or the parent or guardian acting for a minor—grants Counter Culture US, Inc. a non-exclusive, royalty-free, limited license to reproduce, edit, display, publish, distribute, and communicate the Approved Media only as authorized by this Media Consent.
The participant retains ownership of the participant’s original content, subject to any third-party rights in music, choreography, or other included material. This Media Consent does not transfer ownership to Keens Academy.
8. Compensation
Unless a separate written agreement states otherwise, no payment, royalty, residual, or other compensation is due for the approved uses. Refusing this Media Consent does not affect eligibility for the core Services.
9. Withdrawal
The participant or authorized parent or guardian may withdraw this Media Consent for future use by emailing [email protected] and identifying the participant and Approved Media.
Keens Academy will stop initiating new uses within a reasonable period, targeted at 30 days after verifying the request. Withdrawal does not make prior authorized use unlawful and may not require Keens Academy to recall printed materials already distributed, remove third-party reposts beyond Keens Academy’s control, or alter completed historical records. Where reasonably possible, Keens Academy will remove Approved Media from channels it controls and from active future campaigns.
10. Privacy and Retention
Keens Academy will process Approved Media and consent records under the Privacy Policy. Media may be retained during the consent term and for a reasonable period afterward to administer withdrawal, maintain campaign records, comply with law, and protect legal rights. Consent evidence may be retained as long as reasonably necessary to demonstrate authorization.
11. Minors
If the participant is a minor, only a parent or legal guardian with authority may grant this Media Consent. Keens Academy may verify the adult’s identity and authority. A child’s privacy consent for assessment does not automatically authorize marketing use.
Where age and maturity make it appropriate, Keens Academy should also seek the minor participant’s affirmative agreement and respect an objection even when a parent has legal authority to consent.
12. Governing Law and Local Rights
To the extent permitted by applicable law, this Media Consent is governed by the laws of the State of Delaware, without regard to conflict-of-law rules. Mandatory privacy, publicity, consumer, and child-protection rights where the participant lives remain in effect.
If any provision is unenforceable, it will be limited or separated only to the extent necessary, and the remaining provisions will continue in effect.
13. Adult Participant Consent
Complete this section only if the participant is an adult with legal capacity.
☐ I voluntarily authorize only the elements, purposes, channels, territory, and term selected above.
☐ I understand that this consent is optional and may be withdrawn prospectively.
Adult Participant Full Legal Name: __
Electronic Signature / Typed Full Legal Name:
Date and Time: __
14. Parent or Legal Guardian Consent for a Minor
Minor Participant Full Legal Name: __
Minor Participant Date of Birth:
Parent / Legal Guardian Full Legal Name: ___
Relationship to Minor: _
Parent / Guardian Email:
☐ I confirm that I am the minor’s parent or legal guardian and have authority to grant this consent.
☐ I voluntarily authorize only the elements, purposes, channels, territory, and term selected above.
☐ I understand that this consent is optional and may be withdrawn prospectively.
Parent / Guardian Electronic Signature / Typed Name: ___
Date and Time: __
Minor Participant Assent, when appropriate:
15. Keens Academy Use Record
Approved By / Internal Owner:
Campaign or Publication Reference: _
Consent Version: 1.0
Consent Expiration Date: __
Withdrawal Status / Date, if any: ___