Photo Model Release Form

I, ______________________ consent that the photographs, artwork, audio, video, or writing submitted may be used by NY-NJ Trail Conference, its assigns or successors, in whatever way they desire, including television, CD-ROMs, and any other form for the storage, retrieval and reproduction of information, images; furthermore, I hereby consent that such information, photographs, videos, and the plates and/or tapes from which they are made shall be their property, and they shall have the right to sell, duplicate, reproduce and make other uses of such information, photographs, videos, recordings, and plates as they may desire free and clear of any claim whatsoever on my part.

IN WITNESS WHEREOF I have hereunto set my hand, in the State of ____________________, this _______ day of _____________, 200_.

Name: ___________________________________
Age: ___________________________________
Signature: ___________________________________
Name of Parent/Guardian ___________________________________
Signature of Parent/Guardian: ___________________________________
Street Address: ___________________________________
City, State, Zip Code: ___________________________________
Phone Number: ( ___ ) _____________________________

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NY-NJ Trail Conference CONSENT FORM for ADULTS

I, being of legal age, hereby consent that the photographs, artwork, or writing provided by me, photographs and/or videos in which I appear, and/or recordings made of my voice may be used by NY-NJ Trail Conference, its assigns or successors, in whatever way they desire, including television, CD-ROMs, and any other form for the storage, retrieval and reproduction of information, images and sounds; furthermore, I hereby consent that such information, photographs, videos and recordings, and the plates and/or tapes from which they are made shall be their property, and they shall have the right to sell, duplicate, reproduce and make other uses of such information, photographs, videos, and recordings, plates and tapes as they may desire free and clear of any claim whatsoever on my part.

IN WITNESS WHEREOF I have hereunto set my hand, in the State of ___________________, this _______ day of _____________, 200__.

Name: ___________________________________
Signature: ___________________________________
Street Address: ___________________________________
City, State, Zip Code: ___________________________________
Phone Number: ( ___ ) _____________________________

V3 Last updated: April 2, 2006   Copyright © 1996-2005  New York-New Jersey Trail Conference Privacy Statement.