I, Your First Name   Your Last Name   , the adult applicant, parent and/or legal guardian of   Child's First Name   Child's Last Name  hereby acknowledge and understand that I may have certain legal rights against PALAMA SETTLEMENT, their predecessors, successor and assigns, in the event of an accident and/or injury to my child/self or damage to property by PALAMA SETTLEMENT. NOW, THEREFORE, for good and valuable consideration, including but not limited to services provided to my child and/or me, I do hereby voluntarily and with full knowledge of my rights, completely and forever waive, release, acquit, and forever discharge PALAMA SETTLEMENT, its officers, directors, employees, agents and all other persons acting on their behalf (registered approved volunteers) (collectively “Released Parties”), jointly or severally, their successors and assigns, whether herein named or referred to or not, of and from any and all, and all matter of, actions and causes of action, rights, suits, demands, covenants, contracts, agreements, judgments, claims and demands, attorneys’ fees and costs or and damages of whatever name or nature whatsoever in law or equity, which heretofore have been, and which hereafter may be sustained.Further, I agree to defend, indemnify and hold harmless Released Parties from any and all claims, actions, causes of action, suits, expenses, damages of any nature and liabilities, including but not limited to attorneys’ fees and costs, arising out of or relating in any way to the services provided to my child or me by PALAMA SETTLEMENT and/or my or my child’s participation in any class, event or other activity provided or sponsored by PALAMA SETTLEMENT.

I, Your First Name   Your Last Name   , hereby grant permission to Palama Settlement, a Hawaii non-profit corporation (“Grantee”), to use and permit the use of, for any purpose, my name, image, in video, still, or other format, and the likeness and sound of my voice as recorded on audio, video or other forms of media (collectively, the “Materials”), across any and all formats and without payment or any other consideration to me. I fully and voluntarily understand that the Materials may be edited, copied, exhibited, published, or distributed, at the discretion of Grantee, and waive the right to inspect the Materials prior to Grantee’s use thereof. Additionally, I waive any right to royalties or other compensation arising or related to the use of the Materials. I also understand and acknowledge that the Materials may be used in diverse commercial, charitable, educational, and other settings within an unrestricted time period and geographic area.

The Materials may be used for ANY USE OR PURPOSE which may include but is not limited to: (i) presentations; (ii) courses; (iii) online/internet videos; (iv) advertisements/promotions; (v) news releases; (vi) oral histories; and (vii) archives.

I hereby release Grantee, all of Grantee’s representatives, employees, managers, members, officers, directors, parent companies, subsidiaries, sponsors, and agents, from all claims and demands arising out of or in connection with any use or exploitation of the Materials, including, without limitation, all claims for invasion of privacy, infringement of my right of publicity, defamation and any other personal and/or property rights.

The validity of this Media Release Form shall not expire and there is no geographic limitation on where the Materials may be distributed.

In case any one or more of the provisions contained in this Media Release Form shall become invalid, illegal or unenforceable in any respect, the validity, legality and enforceability of the remaining provisions contained herein shall not in any way be affected or impaired thereby and shall remain in full force and effect.

By signing this Media Release Form, I acknowledge that I have completely read and fully understand all of the provisions herein and completely and voluntarily agree to be bound by all of such provisions.
Name:   First Name   Last Name   

Address:   Street Address   Address Line 2   City   State   Zip   
  
Phone   Area Code   Phone Number   
Fax   Area Code   Fax Number   
Email Address   Email   
Signature:
Signature    

If this release is obtained from a presenter under the age of 18, then the signature of that presenter’s parent or legal guardian is also required below.
Signature