Photo / Video Acknowledgement and Release Form


Photo / Video Acknowledgement and Release Form
* YOU MUST BE 18 YEARS OF AGE AND OLDER TO COMPLETE THIS FORM. PLEASE READ CAREFULLY.

Student Name:


Address:


Guardian Name:


Guardian Phone:


Guardian Email:


PHOTO/VIDEO ACKNOWLEDGEMENT AND RELEASE:

I hereby acknowledge that all right, title and interest in video(s) and/or photograph(s) in which I have participated, being original works, belong to “101885 P.E.I. Inc. o/a Dance Stars Academy” and that the said video(s) and/or photograph(s), its titles and all other constituents were prepared under the direction or control of “101885 P.E.I. Inc. o/a Dance Stars Academy”. I hereby re- lease “101885 P.E.I. Inc. o/a Dance Stars Academy” from all claims which I may have now or in future for compensation of any kind arising out of my participation in the said video(s) and/or photograph(s) and acknowledge that “101885 P.E.I. Inc. o/a Dance Stars Academy” may use the video(s) and/or photograph(s) in social media, advertising, and archiving.

ACKNOWLEDGEMENT:

I acknowledge that I have carefully read this agreement that I agree to conform and comply with this agreement in its entirety, that I have executed it voluntarily, and that this agreement is binding. I am aware that by signing this agreement I am waiving certain legal rights which I or my heirs, next of kin, executors, administrators and representatives may have against “101885 P.E.I. Inc. o/a Dance Stars Academy” and its nominees, associates, affiliates, employees, agents, representatives, successors and assigns.

Student or Guardian Name (please print):


Signature must be of a parent or guardian if student is less than 18 years

Student or Guardian Signature:


Signature must be of a parent or guardian if student is less than 18 years

Date: