423 Video Release Form

I grant permission to 423 Communities International the rights of my image, in video or still, and of the likeness and sound of my voice as recorded on audio or videotape without payment or other consideration. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I also understand that this material may be used in diverse educational settings within an unrestricted geographic area. Photographic, audio or video recordings may be used for the following uses: Courses and educational materials, film (movie), media, news (press), online / internet videos, presentations, social media, website postings, Churches, and 423 Communities sponsored events. By authorizing this release, I understand I am giving permission for my photographic images or video recordings to be electronically displayed via the Internet or in a public educational setting. I will be first consulted for permission about the use of my photographs or video recording for any purpose other than those listed above. There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed. By signing this release, I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I release any and all claims against any person or organization utilizing this material for the above-named purposes. *

First Name

Last Name

Date *

MM

DD

YYYY

If this release is obtained from a presenter classified as a minor, then the signature of that presenter’s parent or legal guardian is also required.

First Name

Last Name

I acknowledge that by typing my name above, I am agreeing to the conditions of this form and above documents, and that for the purposes of 423 Communities my typed name shall be considered as an original signature for all purposes and shall have the same force and effect as an original signature. *

I agree