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3 Student Information Please ensure this section is complete and legible. We will use the information listed in this section for mailed notification and for any additional contact. First Name: MI: Last Name: Mailing Address: City: State: Zip: Phone: Cumulative Grade Point Average (Last fully completed quarter or semester): High School Information Names of High School: Mailing Address: City: State: Zip: Phone: Publicity Release 1. In consideration of my participation in the Disneyland Resort Scholarship Program and related activities (individually an Event and collectively the Events ), I do hereby grant to Walt Disney World Co. ( Disney ) and its parent, subsidiary, related and affiliated companies, and their respective successors, affiliates, licensees and assigns (singularly, Disney Party and collectively, the Disney Parties ), forever and throughout the world, the right to take, create and use, and the right to authorize other parties to use and re-use, reproductions (audio and visual), photographs, and recordings of my likeness, voice and sounds during my appearance at any Event for Disney and/or any Disney Party, and the right to re-use such reproductions, photographs and recordings as well as my name and biography, as any Disney Party may desire, in all media, whether now known and/or hereafter devised, throughout the universe in perpetuity (including, without limitation, in any print media and/or publications, on the internet, on basic cable, free and pay television systems worldwide and all supplemental market uses, video cassette, DVD and/or video disc), and in all forms (including, without limitation digitized images), without further compensation to me or any limitation whatsoever, including, without limitation, in and in connection with (a) the production, exhibition, distribution, advertising, promotion and/or other exploitation of any program and/or production and/or other medium embodying the performance of my services to Disney and/or any Disney Party, (b) the exhibition and/or broadcast and distribution, theatrically and/or on television and/or radio, of any motion picture film, video tape and/or audio recording in any medium now and/or hereafter existing in which my physical likeness and/or voice may be used and/or incorporated, (c) the publication, in magazines, newspapers and otherwise, of any articles in which my physical likeness may be printed, used or incorporated, and (d) the advertising, exploiting and publicizing of the Disney Parties, the Disney theme parks (including, without limitation, the studios) and/or any motion pictures, television programs, radio programs, videos, audio recordings, magazines, newspapers and other publications; provided, however, that to the extent Disney determines, in its sole discretion, that AFTRA, AFofM, SAG and/or any other applicable guild and/or union has jurisdiction in respect of any such re-use, then I shall be entitled to receive for such re-use, the applicable minimum compensation required by AFTRA, AFofM, SAG and/or any other applicable guild and/or union with jurisdiction in respect of such re-use to be paid therefor, and Disney shall have the maximum rights and benefits permitted under the AFTRA, AFofM and/or SAG Code and/or any other applicable guild and/or union code for the compensation payable hereunder in respect of my services and any additional compensation payable hereunder in respect of such re-use. 2. I agree that the foregoing grant includes the right to use my physical likeness in any form, including without limitation, a photograph, picture, artistic rendering, silhouette and/or other reproduction by photograph, film, tape or otherwise. 3. I represent that the consent of no other person, firm, corporation or labor organization is required to enable the Disney Parties to use my likeness and/or voice as described herein and that such use will not violate the rights of any third parties. 4. I acknowledge that nothing herein requires any Disney Party to use my likeness or voice. 5. I acknowledge that the rights granted herein include the rights to use excerpts and/or stills from any performance that may contain my likeness and/or voice and to edit, delete and/or juxtapose any part of any performance and to change the sequence of events of any performance. 6. I hereby certify and represent that I have read the foregoing and fully understand the meaning and effect thereof, and, intending to be legally bound I have signed this Authorization on the date set forth below. Student Signature: Date: Parent/ Guardian Signature: (if student is under 18 years of age)

4 Your Passion for Volunteering Describe why you volunteer and what purpose you believe it serves in the community:

5 Volunteer Project Summary Please describe one specific volunteer service activity that you feel demonstrates excellence and highlights your volunteerism: (Provide measurable outcomes or numbers if possible). Contact information for the non-profit organization that benefited from the project described above: Name of the non-profit organization: Mailing Address: City: State: Zip: Phone:

6 What specific tasks or activities were performed and how did you demonstrate leadership: How did the project benefit the organization: What was the outcome of the project:

7 List other extracurricular activities which you have participated in or led during the last two years: (School clubs, student government, publications, sports, theater arts, Scouting, etc.) List any leadership positions held during the last two years: (School clubs, student government, publications, sports, theater arts, Scouting, etc.) Briefly list all volunteer community service projects and hours worked during high school attendance: (Provide additional pages as necessary) Date: Non-Profit Organization: Event Name: Duties: Hours: TOTAL HOURS