Media Release

The following media release is required for participation in all programs, scholarships and events sponsored by Kids On the Move for Success. In order to complete this form you must be eighteen (18) years of age or older. If the individual applicant is a minor child, please have a parent or legal guardian complete the following form. You can download the MEDIA RELEASE FORM to complete and submit it at a later date. If you have additional information or documentation to submit, please email it to apps@kidsonthemoveforsuccess.org. Thank you!

MEDIA RELEASE

Be it hereby known that I, the individual signed below (“Releaser”), do hereby give, consent, and forever grant to Kids On the Move for Success, Inc. and/or Antoinette Tuff LLC (“Assignee”), its representatives, licensees, marketers, and any other related parties or publishers of its promotional materials and their successors and assigns, the right to use, publish and copyright my picture, portrait or likeness, in photo, video and film format, in whole or part, including alterations, modifications, derivations, and composite thereof, in CDs, films, advertising and similar such promotions and renditions throughout the world. This right shall include the right to combine my likeness with others and to alter my likeness by digital or other means.

I further release all rights that I, or my heirs might have now and/or in the future to all or part of the said production, including but not limited to the publishing, printing, development, editing, and use in newspapers and other forms of printed media, social media, broadcasting, cablecasting, webcasting, podcasting, video on demand, or any other public or private presentation or screening purposes by developed or designed by the Assignee or its successors and assigns.

I also hereby release the Assignee and such other parties from any obligation to make any payment hereunder or from any other liability incurred in connection with the use of any of the materials described above. I knowingly and willingly waive any and all rights or entitlements, including payments for my appearance or for the subsequent distribution of the products related to this program.

Releaser hereby acknowledges his/her full and complete satisfaction with the terms of this Media Release and agrees to remit a completed SCHOLARSHIP APPLICATION or VOLUNTEER APPLICATION and/or all other forms as deemed necessary for consideration and participation in the programs and scholarships offered by Kids on The Move for Success, Inc.

 


APPLICANT DISCLOSURES


ELECTRONIC SIGNATURE