Youth Name * First Name Last Name Parent/Guardian Name * First Name Last Name Parent/Guardian Email * Parent/Guardian Phone (###) ### #### Checkbox * By checking this box I hereby acknowledge for valuable consideration, I the abovesigned parent/guardian of the minor model mentioned above ("Model"), hereby grant Hillyard Built, Hillyard Built’s legal representatives and successors, as well as persons and companies, including acting with its permission, the irrevocable right and permission, throughout the world, in connection with the photographs/digital video it has taken of the Model, or in which the Model may be included with others, the following: (a) the right to use and reuse and publish, in any manner at all, said photographs/video, in whole or in part, modified or altered, either by themselves or in conjunction with other photographs/video, in any medium or form of distribution, and for any purposes whatsoever, including, without limitation, all promotional and advertising uses, non-commercial or commercial display, broadcast, exhibition of the final production, and other trade purposes; and (b) the right to copyright said photographs/video in his/her own name or in any other name that he/she may select. I waive the right to inspect or approve the finished product or copy and any use thereof. I agree that the photographs/digital video, reproductions, and negatives thereof shall constitute the photographer's sole property, and that the photographer has the full right to dispose of any or all of them in any manner whatsoever. I hereby forever release and discharge Hillyard Built and its respective representatives, licensees, successors and assigns, and its clients, from any and all claims, actions and demands arising out of or in connection with the use of said photographs/digital video, including, without limitation, any and all claims for invasion of privacy and libel. I acknowledge that this release document was digitally signed by me willingly and I certify that I am the parent/guardian of the Model mentioned above, and I consent to the above statements on their behalf. By checking this box I decline usage of any visual representation Thank you!
