This Authorization and Consent to Use Photograph or Image, and use of Voice is given by the undersigned to the Champions for Champions, Inc and it's events.
As part of the Champions for Champions or matters in connection therewith, photographs, film, videos or other types of medium may be taken or used. In connection therewith, the picture (either still or in action) of the undersigned, or his/her child, may be taken.
Acknowledging the foregoing, the undersigned hereby gives consent and authorization to the Champions for Champions for the use the photograph, picture or image (either still or in action) of the undersigned and/or the undersigned’s child in any publication, website, commercial, or other medium for or on behalf of the Champions for Champions, and waives and forever releases the organization from and against any and all claims, demands or causes of action arising out of, or associated with, the Champion's use of the photograph, picture or image.
The authorization and consent granted herein shall continue in full force and effect until a written revocation is executed and delivered to the Champions for Champions, Inc. 240 SE 17th St, Ocala, FL 34471. A photocopy of this document shall be deemed to be an original. Before I signed this document, I was given the opportunity to read it. I was also given the opportunity to consult with any person, including an attorney, if I desired to do so. I have signed this document freely and voluntarily on the date set forth below.
Participant's Name: ________________________________________________
Signature of Parent or Guardian: ____________________________________
Signature of Participants (if 18 or over): _________________________________