Michigan Model Release Form 3

Transcript

Accredited by the Michigan Non-Public School Accrediting Association Minor Subject/Model Release Upon agreement of the terms stated within this document, I hereby give authorization and permission to the St. Anne Catholic Grade School and their legal representatives and assignees to unrestricted permission to copyright, use, re-use, publish, and republish photographic portraits or pictures of the minor herewith stated in which he/she may be included intact or in part, composite or distorted in character or form within all legal limitations of materials involving minors. Upon this agreement I acknowledge the minor’s likeness and/or legal name can be used in both printed and web materials which may be viewed by the general public. I hereby release the St. Anne Catholic Grade School from all and any claims and demands ensuing from or in connection with the use of the photographic materials by individuals outside the organization including claims for libel and invasion of privacy. I have read and understand the full agreement stated above and represent that I am the parent/guardian of the hereby named minor, and consent to the foregoing on his/her behalf. Minor’s Legal Name:______________________________________________________ Parent(s) Signature: ________________________________________ Date:__________ Parent(s) Name:__________________________________________________________ Address:________________________________________________________________ City:_______________________________________ST:________ZIP:______________ Country:________________________________________________________________ Phone: _______________________ Email:_____________________________________ _____________________________________________________________________________________________