Photo Media Release Form for a Minor
(For Participants under the age of 18)
I do here by consent to the publication of my child’s name and/or my child’s
likeness (“Likeness”) for the purpose of promotion, publicity, advertising and of
other manner of media by the VHPA, or any other representative authorized to act on
behalf of the afore mentioned entity. Likeness shall include, but not limited to,
still photographs, sound and/or video recordings, films, broadcasts, brochures,
publications, reports, webpages, promotional materials or any other audio-visual,
electronic, printed, tangible work in any media or format, now known or hereafter to
become known, and/or reproductions of any of these. I agree that the actual material
involved is and shall continue to be the property of the VHPA and that neither I nor
my child shall have any rights of review or approval regarding the use of my child’s
name and/or Likeness in such materials.
I hereby release and hold harmless, VHPA, Program, ECC along with their respective
employees, volunteers, agents, affiliates, sponsors, or other representative from
any and all claims, demands, or causes of action arising out of use of my child’s
name and/or Likeness, in accordance with the terms of this release. I understand and
agree that neither I, nor my child, will be compensated in any way for the use of my
child’s name and/or Likeness by VHPA, Program or ECC.