Videography/Still Photography Talent Release
I, (print name) _________________________________________________ being at least 18 years of
age agree to this Release as follows:
If participant is less than 18 years old:
I am the parent/guardian (circle one) of (print minor child’s name)
_____________________________, a minor child and have full authority to authorize this Release,
which I have read and approved. I hereby release and agree to indemnify BlueShield of Northeastern
New York (BlueShield) and its respective successors and assigns from and against any and all liability
arising out of the exercise of the rights granted by this Release as follows:
Release
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I give and grant in perpetuity to BlueShield and its licensees, successors, and assigns the right to
use, reproduce and publish (including to crop, edit, process, manipulate, or retitle) my
nomination statement, name, voice, image or likeness, any recorded performance, photography,
and/or videography, and circulate the same for any and all purposes, specifically including, but
not limited to, promotional/marketing purposes, in publications, presentations, on websites
and/or to any media (print, broadcast, and/or online digital media) anywhere in the world and
with no time limitation.
I agree that all sound, still photography, or videography recordings of me used and taken by
BlueShield are owned by BlueShield and that BlueShield may copyright material containing the
same. I understand that if I should receive any print, negative, file, or other copy thereof, I cannot
authorize its use by anyone else.
I agree that no advertisement, release, or other material need be submitted to me for any further
approval and BlueShield shall be without liability for any distortion, alteration, or illusionary
effect resulting from the publication of my nomination statement, picture, voice, image, or
likeness. Ultimate determination of whether, and in what context, to use my nomination
statement, picture, voice, image, or likeness is solely within BlueShield’s discretion and I release
BlueShield from any liability arising out of such use.
Nothing herein will constitute any obligation on BlueShield to make any use of any of the rights
set forth herein.
I warrant that I am at least 18 years of age, authorized to grant this consent and release, and I
agree to indemnify BlueShield (or its designee) against any loss, damage, or expense (including
attorneys’ fees) arising from the alleged breach of this warranty.
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Participant Signature (if 18 or older)
Date
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Signature Parent/Guardian of minor participant
Date