Minor Release Form for Coaches Challenge

PERSONAL RELEASE

 

PROGRAM NAME:

 

2017 Built With Chocolate Milk Coaches Challenge (the “Program”)

CLIENT NAME:

 

National Fluid Milk Processor Promotion Board – Built With Chocolate Milk

AGENCY

 

Weber Shandwick

 

For good and valuable consideration, the receipt and sufficiency of which I hereby acknowledge, I agree that above listed Client, its agents, including Agency, its Vendors for the Program and its affiliated companies, and their respective licensees, successors, directors, officers, employees, parent, subsidiaries, affiliates and assigns (hereby collectively called “Licensed Parties”) will have the right to use my name, biographical information, voice, photograph, likeness, performance, and any interviews and recordings of me for public relations purposes in any and all media now known or developed in the future, throughout the world without time restrictions to promote the Client listed above, without compensation or obligation to me.

I acknowledge and agree that my performance, participation, entry and any interviews I give may be recorded and such recordings may be uplinked or distributed to national and local media outlets.  I agree that any filmed, videotaped or recorded interviews, press kits, b-roll footage, video news releases and any other materials produced by the Licensed Parties (collectively, “Materials”) shall be owned solely by the Licensed Parties.  The Licensed Parties shall have the right to use, publish, copyright, edit, adapt and/or modify the Materials in any way. 

I agree that the Licensed Parties will have the right to attribute statements to me, which are expressions of my personal experience and belief, which are contained in the Materials.  I agree that no Materials containing my name, biographical information, quotes, photographs, or recorded interviews needs to be submitted to me for any approval and the Licensed Parties shall be without liability to me for any distortion or illusionary effect resulting from the publication of my photograph or recorded interview.

I expressly acknowledge that I am knowingly and voluntarily taking part in the activities associated with this Program and understand the requirements associated therewith.  I hereby expressly release and forever waive any and all claims, actions, causes of action, demands, rights, damages, costs, attorney’s fees, losses and expenses which I may have against the Licensed Parties to any of the above for accident, personal injury, disability, death, property damage, or loss of any kind or nature suffered by me as a result of or arising from my participation in this Program.

I further agree that the Licensed Parties shall have the right, but not the obligation, to make any use of any of the rights granted in this Release.

I acknowledge that I have carefully read this document in its entirety and understand that it is a release of claims and a waiver of liability regarding my participation in this Program to the extent provided above, and I warrant, represent, and agree that I have the full power and authority to enter into this agreement and that I accept it of my own free will.

 

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Signature                                                                              

 ____________________________________        

Full Name Printed

____________________________________            

Date Signed                                                                   

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Age and Date of Birth – If Under 21, see below.

 

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Address (Street, City, State, Zip)

 

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Phone (day)                                                                                        

___________________________________

Phone (evening)

PARENT OR GUARDIAN CONSENT FOR INDIVIDUALS UNDER EIGHTEEN (18) YEARS OF AGE OR THOSE STILL CONSIDERED A MINOR IN HIS/HER JURISDICTION OF RESIDENCE (UNDER 21 IF A MS RESIDENT, UNDER 19 IF AN AL OR NE RESIDENT):

 

I am the Mother/Father/Legal Guardian (circle one) of the minor who signed the foregoing release. The release is entered into with my agreement and consent, without further compensation.

 

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Signature                                        

________________________________       

Full Name Printed   

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Date Signed