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ELECTRONIC VIDEO/PHOTO RELEASE FORM
PLEASE CHOOSE ONE (1) OF THE FOLLOWING OPTIONS BELOW
Please read below and electronically sign the release form at the bottom.
APPLIES TO THOSE 18 AND OVER
THIS FORM MUST BE COMPLETED BEFORE ATTENDING AN EVENT
I hereby grant Staten Island Autism Warriors (the "Organization") the irrevocable right and permission to use photographs and/or video recordings of my child or children on its website and other websites and in publications, promotional flyers, educational materials, including but not limited to social media, (i.e. Facebook, Instagram, Twitter) or any derivative works, or for any other similar purpose without compensation to me.
I understand and agree that such photographs and/or video recordings of me may be placed on the internet. I also understand and agree that I may be identified by name and/or title in printed, internet or broadcast information that might accompany the photographs and/or video recordings of me. I waive the right to approve the final product. I agree that all such portraits, pictures, photographs, video or audio recordings, and any reproductions thereof, and all plates, negatives, recording tape and digital files are and shall remain the property of the "Organization".
I hereby release,acquit and forever discharge the Staten Island Autism Warriors, its current agents, officers and employees of the above named entities from any and all claims, demands, rights, promises, damages and liabilities arising out of or in connection with the use of distribution of said photographs and/or video recordings, including bu not limited to any claims for invasion of privacy, appropriation of likeness or defamation.
I hereby warrant that I am eighteen (18) years old or more and competent to contract in my own name or, if I am less than 18 years old, that my parent or guardian has signed this release form below. This release is binding on me and my heirs, assigns and personal representative .
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Indicates required field
Name of Individual Photographed/Recorded
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First
Last
Date
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Digital Signature of Individual
*
Date
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Submit
Please read below and electronically sign the release form at the bottom.
APPLIES TO THOSE UNDER THE AGE OF 18
THIS FORM MUST BE COMPLETED BEFORE ATTENDING AN EVENT
I hereby grant Staten Island Autism Warriors (the "Organization") the irrevocable right and permission to use photographs and/or video recordings of my child or children on its website and other websites and in publications, promotional flyers, educational materials, including but not limited to social media, (i.e. Facebook, Instagram, Twitter) or any derivative works, or for any other similar purpose without compensation to me.
I understand and agree that such photographs and/or video recordings of me may be placed on the internet. I also understand and agree that I may be identified by name and/or title in printed, internet or broadcast information that might accompany the photographs and/or video recordings of me. I waive the right to approve the final product. I agree that all such portraits, pictures, photographs, video or audio recordings, and any reproductions thereof, and all plates, negatives, recording tape and digital files are and shall remain the property of the "Organization".
I hereby release,acquit and forever discharge the Staten Island Autism Warriors, its current agents, officers and employees of the above named entities from any and all claims, demands, rights, promises, damages and liabilities arising out of or in connection with the use of distribution of said photographs and/or video recordings, including bu not limited to any claims for invasion of privacy, appropriation of likeness or defamation.
I have read and understand the above text. I understand and agree that it is binding on me, my child (named below) my heirs, assigns and personal representative . I acknowledge that i am eighteen (18) years old or more and that I am the parent/guardian of the child named below.
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Indicates required field
NAME OF CHILD
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First
Last
NAME OF PARENT OR GUARDIAN
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First
Last
[object Object]
DATE
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Digital Signature of Parent or Guardian
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DATE
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Submit
I DO NOT AGREE TO VIDEO/PHOTOGRAPH RELEASE
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Indicates required field
NAME OF INDIVIDUAL
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First
Last
Comment
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Submit