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Release Form
Name
(Required)
First
Last
Email
Are you a Parent/Guardian
(Required)
No
Yes
Consent
(Required)
I hereby grant
The International Rescue Committee (“IRC”), its employees, agents, affiliates, subsidiaries, assigns, licensees and successors, the right to use my image and likeness and any audio/visual representation thereof, in support of its mission. Audio/visual representations of my image and likeness include, but are not limited to, photographs, digital images, video and audio recordings and clips. I acknowledge and agree that IRC owns all of its products containing my image and likeness and any audio/visual representations thereof, and may use such audio/visual representation in any manner or medium without notifying me, including composite or modified representations, in IRC websites, publications, promotions, fundraising materials, posters and exhibitions, as well as for any other use. I further acknowledge and agree that I will not receive any compensation from the IRC related to the use of my image or likeness and any audio/visual representation thereof.
Release
I hereby release IRC, its employees, agents, affiliates, subsidiaries, assigns, licensees and successors, including any firm authorized to publish and/or distribute a finished product containing my image or likeness or any audio/visual representations thereof, from any claims that may arise regarding the use of my image or likeness including, but not limited to, any claims of defamation, invasion of privacy, or infringement of moral rights, rights of publicity or copyright.
I confirm that I have completely read the foregoing, understand its contents, and have voluntarily signed this Consent and Release.
I am the Parent/Guardian of
(Required)
First
Last
the minor whose image or likeness and any audio/visual representation thereof is the subject matter hereof. I have the legal right to consent to and do consent to the terms and conditions of this Consent and Release.
Signature