Release and Waiver
1. License. VISIONS/Services for the Blind and Visually Impaired assists blind and visually impaired
persons of all ages to live independent lives and to educate the public about the capabilities and
needs of blind or visually impaired persons (collectively, “Programs”). In consideration of my
participation in a photo shoot and/or videotaping in connection with the Programs, I (print name)
___________________________ hereby grant to VISIONS/Services for the Blind and Visually
Impaired, its successors, legal representatives and assigns (collectively “VISIONS”) a nonexclusive,
perpetual, irrevocable, worldwide, fully paid-up, right and license (with a right to grant sublicenses to
its affiliates) to use and portray my name, likeness, and other personal identification, and to
reproduce, publicly display, publicly perform and make derivative works based upon, my image,
picture, photograph, voice, and statements or comments (including, but not limited to, in a recorded
and/or transcribed format thereof), in whole or in part, in its printed or electronic publications
(including, but not limited to, newsletters, Web sites, reports to sponsors, and advertising, promotion,
and marketing materials) and in any other form of media, whether now known or hereafter devised,
created as a result of or in connection with the Programs (collectively, “Licensed Purpose”). I agree
that all rights granted hereunder are freely assignable by VISIONS and that VISIONS is under no
obligation to exercise any of the rights granted hereunder. I hereby forever waive any right to inspect
or approve any sound recording, video, written work or other materials created by VISIONS in
connection with the Licensed Purpose (collectively, “Materials”), including, but not limited to, the right
to obtain a copy of the Materials prior to any use by VISIONS. I understand and agree that VISIONS
cannot control use of the Materials by an unauthorized user. Therefore, any claim I may have
concerning any unauthorized use of the Materials must be pursued by me against such unauthorized
user and not against VISIONS.
2. Release. I hereby expressly release and discharge VISIONS from any claim, damage, liability,
cost and expense (including attorney’s fees) arising from invasion or misappropriation of any right to
privacy, publicity or personality that I may have, defamation, or infringement of any copyright or other
proprietary right that I may have based upon or related to the use or exploitation of the Materials or
otherwise related to the right and license granted hereunder. The aforementioned release shall be
binding upon me and my heirs, assigns and legal representatives.
3. Ownership of Intellectual Property. I acknowledge and agree that VISIONS will own all right, title
and interest, including, but not limited to, all copyrights and other intellectual property rights, in and to
the Materials. To the extent that ownership of the Materials does not automatically vest in VISIONS, I
hereby grant and assign to VISIONS all right, title and interest in and to the Materials and agree to
execute all documents reasonably requested by VISIONS to effectuate the foregoing.
4. Compensation. I hereby acknowledge and agree that VISIONS will not compensate me for my
agreement to the matters set forth herein.
5. Entire Understanding. This Release and Waiver expresses the entire understanding between me
and VISIONS with respect to the subject matter hereof. By signing below, I acknowledge that I have
not relied on any representation or warranty, whether written or oral, by VISIONS. This Release and
Waiver will be interpreted and governed by the laws of the State of New York, without reference to
conflict of laws principles. If any provision of this Release and Waiver is found by a court of
competent jurisdiction to be invalid or unenforceable for any reason, the parties nevertheless agree
that the court should endeavor to give effect to the parties’ intentions as reflected in such provision,
and the other provisions of this Release and Waiver will remain in full force and effect.
Complete this sentence if applicable: I state further that the above Release and Waiver was read to
me prior to its execution by: (Print name of reader)
.
I have had sufficient time to review the provisions contained above, have carefully read and
understand them, and agree to be bound by them. I voluntarily and irrevocably give my consent and
agree to this Release and Waiver.
Executed this_____ day of ____________________, 20_____.
Signature of person whose printed name appears above.
Signature _________________________________
Print Name________________________________ Phone _________________________
Address _________________________________________________________________
City, State, Zip ____________________________________________________________
If person is under age 18, or an adult with a developmental or mental disability, his or her parent or
legal guardian must sign:
I, _______________________________________, am the parent or legal guardian of the person
named above. I have read and fully understand this Release and Wavier and hereby give my
consent and agree to all the terms thereof.
_________________________________
(Signature of parent or guardian)
__________________________, 20____
(Date)
Name (print): __________________________________________________________
Relationship to Subject: _________________________________________________
Address: _____________________________________ Phone:__________________
City, State, Zip: ________________________________________________________