MEDIA RELEASE FORM

I, desiring to contribute to the efforts of Aloha United Way, such efforts being deemed by me to be valuable and sufficient consideration for the Photo Consent and Release Agreement, do hereby grant exclusive license, consent and permission to Aloha United Way and its successors and assigns, to take and/or use my photograph, image, portrait, print, video, voice or other appearance or likeness of me, including my full name, signature and other biographical data (collectively, the “Photo”), without compensation, for any promotional purpose it may deem proper in aid of Aloha United Way programs and efforts. I acknowledge that my Photo may be used and distributed through any medium, including, but not limited to newspapers, magazines, brochures, posters, pamphlets, television, videotapes, compact discs, internet websites, digital media and other print, video or electronic methods of communication.
 
I relinquish and give to Aloha United Way and its successors and assigns, all right, title and interest which I may have in my Photo, including any finished or undeveloped pictures, negatives, reproductions and copies thereof and, except where I have provided my Photo to Aloha United Way, acknowledge that Aloha United Way  shall be the sole owner and copyright holder thereof. I further grant to Aloha United Way the right to give, transfer and exhibit my Photo in any manner, as determined in the sole discretion of Aloha United Way . I further waive any right that I may have to inspect and approve the finished product or the advertising or promotional copy that may be used in connection therewith, or the use to which it may be applied.
 
If my Photo has been provided to Aloha United Way by me, I represent that I am the sole owner of my Photo, that I have the legal right and authority to provide my Photo to Aloha United Way, and that doing so will not violate any law or the rights of any other person.
 
I further agree to release, discharge, indemnify and hold harmless Aloha United Way, its successors and assigns, and any and all persons acting under their permission or authority, from and against any and all claims, demands, actions, liability, losses, judgments, awards, costs and expenses, including attorneys’ fees, of any kind or nature whatsoever by whomsoever raised or asserted, arising out of, related to or connected with the use of my Photo.
 

Name of Photo Owner or Person Photographed *

Name of person submitting the form

Parent / Guardian Name (if under 18 years of age)

Files must be less than 15 MB.
Allowed file types: gif jpg jpeg png.
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