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VIDEO AND PHOTO RELEASE FORM
Alphalete Gym, LLC
711 Avenue E
Stafford, Texas 77477

281-969-7545

 

 

By signing this release form I authorize Alphalete Athletics to use the following personal information: 

(1) My picture – including photographic, motion picture, and electronic (video) images. 

(2) My voice – including sound and video recordings. 

I hereby grant to Alphalete Athletics Gym its subsidiaries, licensees, successors and assigns, the right to use, publish, and reproduce, for all purposes, my name, pictures of me in film or electronic (video) form, sound and video recordings of my voice, and printed and electronic copy of the information described in sections (1) and (2) above in any and all media including, without limitation, cable and broadcast television and the Internet, and for exhibition, distribution, promotion, advertising, sale, press conferences, meetings, hearings, educational conferences, social media platforms, and in brochures and other print media. This permission extends to all languages, media, formats and markets now known or hereafter devised. This permission shall continue forever unless I revoke the permission in writing.

I further grant Alphalete Athletics Gym and its subsidiaries, licensees, successors and assigns all right, title, and interest that I may have in all finished pictures, negatives, reproductions, and copies of the original print, and further grant Alphalete Athletics Gym the right to give, sell, transfer, and exhibit the print in copies or facsimiles thereof, for marketing, communications, or advertising purposes, as it deems fit. 

I hereby waive the right to receive any payment for signing this release and waive the right to receive any payment for Alphalete Athletics Gym’s use of any of the material described above for any of the purposes authorized by this release. I also waive any right to inspect or approve finished photographs, audio, video, multimedia, or advertising recordings and copy or printed matter or computer generated scanned image and other electronic media that may be used in conjunction therewith or to approve the eventual use that it might be applied. 

I acknowledge that I have read the foregoing and I fully understand the contents.                  

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First Name*

Last Name*
First Your Date of Birth*
I certify that I am 18 years of age or older
First Your Signature*
Parent or Guardian's Email Address

Email*

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Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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