Photo Release Form

I,

with a mailing address of

City of

State of

(the "Releasor") grant permission and consent to Black Girls Cheer & Affiliates (the “Releasee”) for the use of the following photograph(s) as identified below for presentation under any legal condition, including but not limited to: publicity, copyright purposes, illustration, advertising, and web content:

Payment: I understand that there shall be no payment for this release.
Agree

Royalties: I understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.
Agree

Revocation: I understand that with my authorization below the photograph(s) may never be revoked.
Agree

Revocation: I understand that I may revoke this authorization at any time by notifying the Releasee in writing. The revocation will not affect any actions taken before the receipt of this written notification. Images will be stored in a secure location and only authorized staff will have access to them. They will be kept as long as they are relevant and after that time destroyed or archived.
Agree

We, the Releasor and Releasee, understand and agree to the aforementioned terms and conditions.

Releasor’s Signature & Date

Parent/Guardian Signature & Date (If under 18)

Email Address (to receive a copy of your submission)

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