Media Release Form

562.843.7801 [email protected]

Media Release Form

* Indicates required field

I

Name (parent or guardian) *

, hereby release the image, likeness and voice of

Name (son or daughter) *

as recorded for the use in a promotional / educational video or presentations for Power Partners USA – Power Tie Giveaway. I agree that the footage may be edited and used in whole or in part in all media including but not limited to audio, photos and video on the internet, ratio and cable broadcast and all other purposes in perpetuity throughout the world. We may use your child’s name but not any biographical information in connection with the distribution and promotion of the video content. We are asking this media release for our participation in the Semi-Final and possibly Finals at the University of Notre Dame McCloskey Business Venture competition. Otherwise, we follow the LBUSD's social media guidelines.

I expressly release Power Partners USA – Alan Armijo, from any defamation and other claims I may have arising out of the above described material and hereby waive all rights to impact and approve the finished product or its use.

I acknowledge the release is form and final and submit this form to signify my agreement.

Parents Full Name *

Phone Number *

Child’s Name *

Date: *

Submit

Media Release Form

I

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