Talent Release Form

Name

First name

Last name

Phone number

Email address

Parent / guardian of (please print child (patient) full name)

I am signing on behalf of myself and/or my child / family;
I consent to the collection, storage and use of my, my child’s and/or family’s image, likeness and/or voice by the Childhood Cancer Association for purposes including press (e.g. newspaper, TV), print publications, websites including social media and advertisements or any other means of communication;
I consent for my, my child’s and/or family’s image, likeness and/or voice to be provided to and used by any associated third party involved in the event;
I release the Childhood Cancer Association from any claim by me or anyone on my behalf for any cost, expense, loss or damage arising out of the collection, storage, disclosure or use of my /my child’s and/or family’s image and/or voice by the Childhood Cancer Association for purposes including press (e.g. newspaper, TV), print publications, websites including social media and advertisements or any other means of communication;
There will be no payment, compensation, or other consideration provided for the use of my, my child's, or my family's image, likeness, and/or voice;
I consent to the use of my, my child's, and/or my family's image, likeness, and/or voice for an indefinite period, unless and until this consent is withdrawn by providing written notice to the Childhood Cancer Association.

Signature

Date

Event Name

Event Date

Date

Time