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Baby Buggy Walk in the Park – Sample Photo Release Form

Sample Photo Release

Authorization to Use Photographs and/or Audio-Visual Recordings

I hereby grant [organization name] permission to use, reproduce, or publish my image, likeness, or voice without compensation or any other consideration, in photographs and/or video for purposes of publicizing [organization name] programs and initiatives and for any other lawful purpose.

I understand that these photographs and audio-visual recordings are the property of [organization name] and will not be returned. I also understand that these photographs and audio-visual recordings will be in the public domain and [organization name] may further reproduce, edit, alter, copy, exhibit, publish, or distribute these photographs and audio-visual recordings without further permission.

I waive the right to inspect or approve the finished product, including any written or electronic copy, wherein my image, likeness, or voice appears. In addition, I hereby hold harmless and release and forever discharge [organization name] from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I have read this authorization before signing below and I fully understand the contents, meaning, and impact of this authorization.


Printed Name


Signature

Date


_____ [organization name] MAY use my real name.

_____ [organization name] MAY NOT use my real name.

If the person signing is a minor, there must be consent by a parent or guardian, as follows:

I hereby certify that I am the parent or guardian of ________________________, named above, and do hereby give my consent without reservation to the foregoing on behalf of this person.


Printed Name of Parent/Guardian of Minor Participant


Signature of Parent/Guardian of Minor Participant

Date


Minor Participant(s) Name(s) and Age(s)

1/31/2017 11:18:00 AM