CB2RB Media Consent and Release Form

Combat Boots 2 Red Bottoms Media Consent and Release Form
Date

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Date
Name of Releasor

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Email of Releasor
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Phone Number of Releasor
Address of Releasor

Street Address

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I, {nameOf9} (hereinafter referred to as "Releasor"), grants permission to ProDeo Enterprise (Combat Boots 2 Red Bottoms) (hereinafter referred to as "Releasee"), of 123-A Hwy 80 E 107, Clinton, Mississippi, 39056 to use my media (photograph image and/or video footage and/or audio recordings).

The media may be copyrighted, used and/or published individually or in conjunction with other photography, video works, and recordings, and in any medium (including without limitation, print publications, public broadcast, CD-ROM format) and for any lawful purpose, including without limitation, trade, exhibition, illustration, promotion, publicity, advertising and electronic publication.

Releasee is released (and all persons acting under its permission or authority) from all claims for libel, slander, invasion of privacy, infringement of copyright or right of publicity, or any other claim related to the Image and/or Voice (collectively, "Claims" ). This release includes, without limitation,n any Claims related to blurring, distortion, alteration, optical illusion, digital alteration, use in composite form, whether intentional or otherwise, or use of a fictitious name, that may occur or be produced in the processing or publication of the Image and/or Voice.

I likewise understand that I may be identifiable from the reproduction of the media by the Releasee indicated herein this agreement.

I hereby waive my rights to inspect or approve the media for production that may be used by the Releasee for purposes stated herein, from hereon forward.

I likewise waive any right to royalties or any compensation arising from or related to the use of the image.
Attestation of Legal Age

I certify that I am of the legal age (18 years old or older)and competent to contract in my own name. I have read this release before signing below and I fully understand the contents, terms, and the effect of this release.
Date

MonthDayYear
Date
Signature of Releasor or Releasor's Guardian

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Combat Boots 2 Red Bottoms Media Consent and Release Form