Photo / Video Release Form

I, ____________________________________________________________(please print),
grant permission to KBringle Designs and its agents and employees the irrevocable and unrestricted right to reproduce the photographs and/or video images taken of me, or members of my family, for the purpose of publication, promotion, illustration, advertising or trade, in any manner or in any medium.
I hereby release KBringle Designs and its legal representatives for all claims and liability relating to said images or video. Furthermore, I grant permission to use my statements that were given during an interview with or without my name, for the purpose of advertising and publicity without restriction.
I also waive my right to any compensation.

I acknowledge that I am:                           [    ] over the age of 18 years
                                                                  [    ] the parent or legal guardian of the following

If legal guardian of photo or video subject(s), please list name(s) below:


Name: ___________________________________________________________
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Signature: ________________________________________________________
Date: ____________________________________________________________
Address:__________________________________________________________

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