I, the undersigned adult participant or parent/legal guardian of the above named minor participant hereby grant to
the above named School/Parish/Diocesan Entity the following irrevocable rights:
- 1. To use the name, photograph, picture, portrait, voice, appearance, likeness, performance (hereinafter
collectively known as “image”) of the above named participant in connection with its educational,
promotional, fund-raising activities, or for any other legitimate purpose;
- 2. The right to use, reproduce, publish, exhibit, distribute, and transmit the image of the above named
participant individually or in conjunction with other images or printed matter in the production of
brochures, slides, motion pictures, broadcasts (radio and television), audio or video files, recordings, still
photography, CD-Rom and any other manner of media now known or later developed;
- 3. The right to use, reproduce, publish, exhibit, distribute, and transmit the image of the above named
participant individually or in conjunction with other images or printed matter on the
School/Parish/Diocesan’s entity Internet web site. No personal information such as home address or phone
numbers will be published;
- 4. The right to record, reproduce, amplify, edit, and simulate the above named participant’s image and all
sound effects produced; and
- 5. The right to copyright, in its own name, works that contain the image of above named participant; and
- 6. The right to assign the above-mentioned rights to third parties.
I understand that the video files, still photos, or other media incorporating the image the above named participant
will become the property of the School/Parish/Diocesan Entity. I hereby waive the right to inspect or approve the
image or any finished materials that incorporate said image.
I understand and agree that no compensation will be provided, now or in the future, in connection with the use of
the above named participant’s image, and nothing herein will create any obligation on the part of
School/Parish/Diocesan Entity to make use of the rights or materials set forth herein.
I hereby release and forever discharge Frank J. Dewane, as Bishop of the Diocese of Venice, his successors in
office, a corporation sole, The Specified Catholic School/Parish/Diocesan Entity, their
agents, employees and assigns from any and all claims demand, rights, and causes of action of whatever kind that
may arise from the use of above named participant’s image, including all claims for libel and invasion of privacy.
I hereby certify that I am the above named participant or the parent/legal guardian of the above referenced minor,
and I give my consent, without reservation, to the above agreement on behalf of myself or said minor. This
agreement shall be valid for a period of four years from the date hereof, unless revoked in writing.
