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MEDIA RELEASE FORM

Please fill out the following form in order to participate in our activity.

I,                                                                 

 

hereby grant permission to Train:106 LLC, and its representatives to film, record, and photograph my child, 

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and to use his/her likeness, image, voice, and performance in any and all media and formats now known or later developed, including but not limited to film, television, internet, and print.

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I understand that the footage, recordings, and photographs may be edited, modified, and distributed by Train:106 LLC and its affiliates, and that I have no right to review or approve any such materials prior to their use. I waive any right to royalties, compensation, or other payment in connection with the use of my child's likeness, image, voice, or performance.

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I represent and warrant that I am the parent/legal guardian of and have the legal authority to enter into this agreement on his/her behalf. I further represent and warrant that my child is not bound by any agreement or obligation that would prevent him/her from granting the rights set forth in this agreement.

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I acknowledge that Train:106 LLC is relying on the representations and warranties set forth in this agreement, and I agree to indemnify and hold harmless [Train:106 LLC] and its affiliates from any and all claims, damages, and expenses (including reasonable attorneys' fees) arising out of or in connection with any breach of this agreement.

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This agreement shall be binding upon me, my child, and our respective heirs, executors, administrators, and assigns.

Thanks for Submitting

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