Media Release

1. YOUR AGREEMENT

I am the parent/guardian of the child/athlete noted above. I hereby grant The X Count and their agents the absolute right and permission to use
photographic portraits, pictures, digital images or video of My Child, or in which My Child may be
included in whole or part, or reproductions thereof in color or otherwise for any lawful purpose
whatsoever, including but not limited to use in any organization publication or on the organization’s
website websites, without payment or any other consideration. I hereby waive any right that I may have to inspect and/or approve the finished product or the copy that may be used in connection therewith, wherein My Child’s likeness appears, or the use to which it may be applied. I hereby release, discharge, and agree to indemnify and hold harmless The X Count and their agents from all claims, demands, and causes of action that I or My Child have or may have by reason of this authorization or use of My Child’s photographic portraits, pictures, digital images or videotapes, including any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or
otherwise, that may occur or be produced in the taking of said images or videotapes, or in processing tending towards the completion of the finished product, including publication on the internet, in brochures, or any other advertisements or promotional materials. I represent that I am at least eighteen (18) years of age and am fully competent to sign this Release.
THIS IS A RELEASE OF LEGAL RIGHTS. READ IT CAREFULLY AND BE CERTAIN YOU UNDERSTAND IT BEFORE SIGNING (Both parents, if possible)
CONSENT: We/I hereby certify that We/I are/am the parent(s) or guardian(s) of the above named
child/athlete and do hereby give our/my consent without reservation to the foregoing on behalf of My Child.
PLEASE NOTE: We reserve the right, at our sole discretion, to change, modify or otherwise alter these Terms and Conditions at any time. Unless otherwise indicated, amendments will become effective immediately. Please review these Terms and Conditions periodically.