Photo Consent, Release & Waiver Form

 

Without expectation of compensation or other remuneration, now or in the future, I hereby give my consent to Break-n The Cycle Nonprofit Corp (“Break the Cycle”), and its affiliates and agents, to use my, and to the extent applicable my child’s, image and likeness and/or any interview statements from me in its publications, advertising or other media activities (including the Internet).  This consent includes, but is not limited to:

(a) Permission to interview, film, photograph, tape, or otherwise make a video reproduction of me and/or record my voice; 

(b) Permission to use my name; and 

(c) Permission to use quotes from the interview(s) (or excerpts of such quotes), the film, photograph(s), tape(s) or reproduction(s) of me, and/or recording of my voice, in part or in whole, in its publications, in newspapers, magazines and other print media, on television, radio and electronic media (including the Internet), in theatrical media and/or in mailings for educational and awareness.

The Vendor assumes the entire responsibility for losses, damages, and claims arising out of Vendor/Exhibitor’s activities on the venue premises and will indemnify, defend and hold harmless Break the Cycle and their landlords, its owners and its management company, as well as their respective agents, servants, volunteers, and employees from any and all such losses, damages and claims. 

This consent is given in perpetuity, and does not require additional approval by me.