Media Release Form

This is a fill-in form. Please click on the appropriate area to enter information. Tab between fields and PRINT when com...

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This is a fill-in form. Please click on the appropriate area to enter information. Tab between fields and PRINT when completed. If using Adobe Acrobat Reader you CANNOT email the form—no data will be included.

National Forensic League dba National Speech & Debate Association

Statement of Permission and Release Agreement

School Affiliation



State



I hereby grant to the National Forensic League dba National Speech & Debate Association and its affiliates and designees (collectively the “Association”) the irrevocable, perpetual, worldwide right and permission to record my participation in any Association events and activities in which I participate and to use any such video, audio, visual and/or audio recordings in which I am included (the “Recordings”) as well as any materials I create, submit, or use in connection with or related to the Association or its events or activities (“Materials”) or any of portion of the Recordings and Materials, with or without alteration, alone or in conjunction with other images or elements of any type, in any manner, whether now known or later invented, by any means, whether now known or later invented, and in any and all media, whether now known or later invented, without restriction. I acknowledge that the Association has no financial commitment or obligation to me as a result of this Statement of Permission and Release Agreement (the “Agreement”) or the use of the rights granted in the Agreement. I understand and agree that the Association and/or its authorized representatives shall have the exclusive right, title, and interest, including copyright, in and to the Recordings. I hereby release and hold harmless the Association and its authorized representatives from any and all actions, claims, damages, costs, or expenses, including attorney’s fees, which relate to or arise out of any development or use of these Recordings and Materials.

My signature shows that I have read and understand the release and I agree to accept its provisions. I have full right to give this release. Student Name (PRINT)

Signature of Student

Date (mm/dd/yy)



– OR –

Since I am a minor, I give this release subject to ratification by my parent or legal guardian.

Student Name (PRINT)

Signature of Student

Date (mm/dd/yy)

I am the parent/legal guardian of the person signing the release and I hereby ratify it and release all claims whatsoever which either I or the minor may have with respect to the matters covered by the release.

Parent/Guardian Name (PRINT)

Signature of Parent/Guardian

Date (mm/dd/yy)



Please add your address and phone number below.

Street Address City

State

ZIP Code

Day Phone

Granting of permission is voluntary. Return completed agreement to National Speech & Debate Association, 401 Railroad Place, West Des Moines, IA 50265-4730 | Email to [email protected]

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08/15/17

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