CONSENT FORM FOR MINORS: 2020 Virtual Girls Speak Out
NAME OF CONSENTEE___________________________________
(Last) (First) (Middle)
DATE: _______________ ORGANIZATION (IF APPROPRIATE): _____
For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I hereby consent and agree to the following:
- I hereby grant to The Day of the Girl Summit (“IDG Summit”) and The Working Group on Girls (“WGG”) and others working for their behalf, and each of its respective licensees, successors and assigns (each a “Releasee”), the irrevocable, royalty-free, perpetual, unlimited right and permission to use, distribute, publish, exhibit, digitize, broadcast, display, modify, create derivative works of, reproduce or otherwise exploit my name, picture, likeness, creative works, and or voice (including any video footage of the same) (collectively, “Media”), or to refrain from so doing, anywhere in the world, by any persons or entities deemed appropriate by the IDG Summit and WGG, for any purpose (except defamatory) including, without limitation, any use for educational, advertising, non-commercial or commercial purposes in any manner or media whatsoever (whether known or hereafter devised) including, without limitation, online, in print campaigns, social media, in-store and via television. I agree that I have no interest or ownership in any of the Media.
- I shall have no right of approval, no claim to compensation and no claim (including, without limitation, claims based upon invasion of privacy, defamation, moral rights, or right of publicity) arising out of any use, alteration, blurring, illusionary effect or use in any composite form of my name, picture, likeness and voice. I agree that nothing in this Release will create any obligation on the WGG to make any use of the Media or the rights granted in this Release. I hereby release and hold harmless Releases from any claim for injury; compensation or negligence resulting or arising from any activities authorized by this Release and any use of the Media by the WGG.
NAME OF MINOR (please print):____________________________
CITY: _____________________ STATE _____ZIP ___________ COUNTRY _______
PHONE NUMBER: (_____)_____________ADDITIONAL PHONE (optional) (____)__
Release for Minors (those under the age of eighteen): I, the undersigned, being a parent or guardian of the minor, hereby consent to the foregoing conditions and warrant that I have the authority to give such consent.
NAME OF PARENT/LEGAL GUARDIAN (please print) DATE
SIGNATURE OF PARENT/LEGAL GUARDIAN (REQUIRED) DATE
PARENT/LEGAL GUARDIAN EMAIL ADDRESS*: ____________@__________
(*Email addresses will not be used for any other purposes or distributed to third parties)