Form Center

3. 

6. I, the undersigned, hereby grant permission to the City of Valdez, its officers, employees, agents, and assigns (the “City”), to take, use, reuse, publish, republish my likeness (photographic, video-form or otherwise) and voice, for the purposes of advertisement, fundraising, publicity, promotion, trade or any other use by the City, in any and all forms, media and manners, including but not limited to, news releases, websites, social media, photographs, video, marketing and exhibition for an indefinite period of time.

   I warrant that I am the parent or legal guardian of the below-named minor child and have full right and authority to enter into this release on behalf of the undersigned.

   I understand and agree that these images and voice recordings may be used for a variety of purposes, as outlined above, without further notification. And as such, I further agree that I do not have any rights to inspect or approve the finished photographic, video, or audio-recorded products.

   I acknowledge that no compensation, fee, or royalty will be paid for the uses mentioned above of my likeness or voice and that the City owns all rights to the images, video, and recordings and all derivative works created therefrom. Nor will I seek compensation for myself, the undersigned, or any other party.

   I release the City, its officers, agents, and assigns from any and all claims, demands, damages, and liabilities arising out of, or in connection with, the use or distribution of said photographs, video, or audio recordings, including but not limited to, claims of invasion of privacy, defamation, or infringement of copyright, moral rights, or rights of publicity.

   I understand that this consent is perpetual, may not be revoked, and is binding on me, the undersigned minor, our heirs, assigns, or any other third party.

   This Release expresses the complete agreement of the parties and supersedes all prior communications, contracts, or agreements between the parties with respect to the subject matter of this Release, whether oral or written.

   I attest that I have read this Release and fully understand its contents.

8. Parent/Legal Guardian Information
10. Name of Parent/Legal Guardian*
12. Address of Parent/Legal Guardian*
14. City*
15. State*
16. Zip Code*
18. Primary Phone Number of Parent/Legal Guardian*
19. Email Address of Parent/Legal Guardian*
21. Minor Child Information
23. Name of Minor Child*
24. Age of Minor Child*
26. Address of Minor Child

    (If different from parent/legal guardian)

28. City
29. State
30. Zip Code
32. Photo, Video, or Audio Information
34. Name of Person Who Took the Photo, Video, or Audio Recording*
35. Date of Photo, Video, or Audio Recording*
37. Description of Photo, Video, or Audio Recording*
39. Agreement & Submission*

    By providing my signature, I attest that I have read the City of Valdez Photo, Video, and Audio Release Form (Minor) and fully understand its contents.

    1. I agree.
40. Date*
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field