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ECWPA Photo Release

indicates a required answer

I hearby authorize the Enrichment Center to publish photographs of myself and/or the minor child or children listed below on the Enrichment Center website and/or the Enrichment Center Facebook page.

I hearby release and hold harmless the Enrichment Center from any reasonable expectation of privacy or confidentiality for myself and for the minor child and children listed below associated with the images specificed above.  Further, I attest that I am the parent or legal guardian of the child or children listed below and that I have full authority to consent and authorize the Enrichment Center to use their likeness and names.

I further acknowledge that participation is voluntary and that neither I, the minor child, or minor children will receive financial compensation of any type associated with the taking or publication of these photographs.  I acknowledge and agree that publication of said photos confers no rights of ownership or royalties whatsoever.

I hearby release the Enrichment Center from liability for any claims by me or any third party in connection with my participation or the participation of the minor children listed below.

Authorization

1. *

Printed Name

2. *

Signature

By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.
3. *

Date

4. *

Address

5. *

Relationship to child/children

6. *

Child 1 name

7. *

Child 1 age

8. 

Child 2 name

9. 

Child 2 age

10. 

Child 3 name

11. 

Child 3 age

12. 

Child 4 name

13. 

Child 4 age

14. 

Child 5 name

15. 

Child 5 age

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