PHOTO/VIDEO RELEASE FORM - Southeastern

Simple RELEASE form : PHOTO/VIDEO RELEASE form . I hereby give permission for images of my child, captured during _____(Event). through video, photo and digital camera, to be used solely for the purposes of _____(Organization) promotional material and publications, and waive any rights of compensation or ownership thereto. Name of Participant (please print): _____Age: _____. Name of Parent/Guardian (please print): _____. Parent/Guardian s Signature: _____. Date: _____. Philips RELEASE w/name removed (includes provision to include statements re: quotes, testimonials, etc.): RELEASE . In consideration of the opportunity to provide certain statements and participate in photography or audio/video taping relating to certain products of _____ or its affiliated companies (collectively, _____ ), I, _____, for myself and, in the case of a minor (the "Minor"), for myself and the Minor in my capacity as the Minor's parent/guardian, agree as follows: 1.

I hereby consent to the recording of statements, photographs, and/or audio or video recordings taken of the Minor or me by _____ or its contractors. ... Neither the Minor nor I shall receive any compensation in connection with use of these statements, photographs, and/or audio or video recordings for promotional, commercial or other purposes. ...

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