League of Chicago Theatres Media Release Form

Consent Of Media Release

From League of Chicago Theatres
Date

MonthDayYear
Date
Agreed and Accepted by
Releasor Name *

NewSubmission from Member Services Form
Phone Number
Email*
example@example.com
Age of Releasor
Preferred Pronouns of Releasor
ex. they/them, she/her, he/him
The Media obtained shall be used for:*

Marketing, flyer, and brochuresSocial media/websitesVideo UseOther
CONFIRM

I, (hereinafter referred to as "Releasor"), grants permission to League of Chicago Theatres (hereinafter referred to as "Releasee"), to use my media (photograph image and/or video footage and/or audio recordings).

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 the purposes stated herein, from this point forward.

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

I hereby grant permission to publish/use photographs, audio/video recordings of me. I understand that my image and likeness could be used by League of Chicago Theatres for documentary, archival, educational, fundraising, publicity, and promotional purposes.
Attestation of Legal Age*

I certify that I am of legal age 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.
Attestation of Parent/Guardian*

I am the parent or legal guardian of the named minor in this agreement. I have read this release before signing below, and I fully understand the contents, terms, and the effect of this release.
Signature of Releasor or Releasor's Guardian*

Clear
Should be Empty:

Consent Of Media Release

Agreed and Accepted by