MEDIA RELEASE

Name of Participant / Player (Please submit a different form for each participant)*

First NameLast Name

Date of Birth*

Date

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Squash Players School

Squash Players Business

I acknowledge that, from time to time, ORRRC may take photographic images, video recordings, audio recordings, and/or other recordings of programs and/or events, including individuals such as myself who may be participating in and/or observing such programs and/or events, hosted by and/or at ORRRC for various purposes, including but not limited to community building, promotion of ORRRC, and/or marketing. As such, I know and hereby permit images, videos, and/or other recordings of myself to be included in media that ORRRC may, in its sole discretion, upload to social media, the ORRRC website, email, or otherwise publish. By signing this waiver, I agree that ORRRC has my permission to use my likeness and/or voice in such media without condition, limitation, or compensation. The undersigned authorizes the use of photographs of themselves and/or their children to be used in any and all ORR&RC publications, publicity, advertisements and social media.

I have read and understood this entire release form and agree to it.

If Participant is under the age of 18 years of age, or is otherwise deemed to lack the capacity to execute this agreement, the signatory must be the Parent or Legal Guardian of such Participant

Legal Signature (Guardian or Player Over 18)*

Clear

Date*

Date