Minor Photo Release Form
MountainCAP Media, LLC
Parent/Guardian Name
*
First Name
Last Name
Subject's Name
*
First Name
Last Name
Nickname (N/A if none)
Subject's Gender
Please Select
Male
Female
N/A
Jersey Number
Type a number
Team or Group Name
Ex: Wythe Elite 13U
*
Parent/Guardian Phone Number
*
Parent/Guardian Email
*
example@example.com
Authorization and Release
I for good and valuable consideration hereby irrevocably authorize MountainCAP Media, LLC (Cory Parker) to use photographs of my child and authorize his assignees, photographs, pictures, videos or images herein described in any and all forms and media (and in all manners) including composite images, and for the purpose of publicity, illustration, commercial art, advertising, publishing, (including publishing in electronic form or internet websites), for any product or service, or other lawful uses as may be determined by the photographer, Cory Parker, or studio named here to be known as MountainCAP Media, LLC. I further waive any and all rights to review or approve any use of the images/videos, any written copy or finished product. I have read and fully understand the terms of this release. I am the parent of legal guardian of the above mentioned MINOR and have legal right and authority to execute the above release on behalf of the minor.
What is your preference regarding the use of your child's name? Please select one
*
I consent to the use of subject's complete name.
I consent to the use of subject's first name only.
I consent to the use of subject's nickname
I consent to the use of subject's photographs anonymously.
Please check the boxes regarding your preference. Please select all boxes
*
I authorize MountainCAP Media, LLC to use my photos on Facebook, X, Instagram, Youtube, and other social media platforms.
I authorize MountainCAP Media, LLC to edit, alter, copy, or distribute the photos for social media advertising and marketing.
I agree that the photos and all intellectual property rights of the photos belong to MountainCAP Media, LLC
I agree that I will not receive any monetary compensation for usage of my photographs/videos in social media platforms.
Signature
*
Date Signed
*
-
Month
-
Day
Year
Date
Submit
Submit
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