I, the undersigned, as Parent or Guardian of (insert full name of essay applicant), declare that the Essay/Manuscript authored and submitted by him (her) to the Sigma Tau Chapter of Omega Psi Phi Fraternity, Inc. for purposes of consideration in its High School Essay Contest is an original work. I hereby grant to Sigma Tau Chapter a non-exclusive right to publish said work for distribution to members and the public for the purposes of advertising or publicizing the contest and any winners. Distribution may include and not be limited to print, oral or web based, and internet distribution.

I, further acknowledge that I have been apprised of the Fraternity’s policy relating to its use of the essays of participants at the time of application to the Essay Contest. The Essay Application document states:

Person submitting name scripts hereby grant to the Sigma Tau Chapter of Omega Psi Phi Fraternity, Inc a non-exclusive right to keep essay manuscripts and to publish them for the purposes of advertising and publicizing the Essay Contest to members and the general public.

I hereby grant to the Sigma Tau Chapter of Omega Psi Phi Fraternity, Inc. an irrevocable, worldwide license to use, reproduce, distribute, or modify the article in its entirety or portions thereof. I also declare that if any parts of my child’s submission are copyrighted, permission has been sought and received by us, or appropriate attribution has been made. I further agree that the name, likeness, and biographical material, including affiliations of the author, may be used in connection with, and promotion of, the essay/manuscript and/or the Essay Contest itself.

Parent or Guardian Name:
First Name   Last Name   

Telephone:
Area Code   Phone Number   

Address:
Street Address   Address Line 2   City   State   Zip   

Email:
Email   

Parent/Guardian Signature:

I hereby grant Omega Psi Phi Fraternity, Inc. and Sigma Tau Chapter permission to use my likeness in photographs, video recordings or electronic images in any and all of its publications, including website entries, without payment or any other consideration. I understand and agree that these materials will become the property of the Organization and will not be returned. I hereby irrevocably authorize the Organization to edit, alter, copy, exhibit, publish or distribute these images for purposes of publicizing the organization’s programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears.

Additionally, I waive any right to royalties or other compensation arising or related to the use of my image. I hereby hold harmless and release and forever discharge the Organization from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I am 18 years of age and am competent to contract in my own name, or if I am under age 18, a parent or guardian has signed below. I have read this release before signing below and I fully understand the contents, meaning and impact of this release.

Printed Name:

I hereby certify that I am the parent or guardian of , named above, and do hereby give my consent without reservation to the foregoing release on behalf of this person.