I, do hereby give permission to be recorded, photographed and/or videotaped by REVIVE RADIO & MEDIA + REVIVE LOCAL PAPER or its representatives. I understand and agree that the recordings, photographs and/or video footage containing my image and/or voice will be used in the production of publications and/or promotional materials associated with the REVIVE RADIO & MEDIA + REVIVE LOCAL PAPER and that such materials may be distributed to the public and displayed publicly for both non and for profit.

I, also understand that my permission authorizing REVIVE RADIO & MEDIA + REVIVE LOCAL PAPER to use the recordings, photographs and videotapes in such material is for the life of the specific activity for which the materials are intended and that I will not receive compensation for granting this permission.

I, acknowledge that REVIVE RADIO & MEDIA + REVIVE LOCAL PAPER has no obligation to use my image or voice in connection with REVIVE RADIO & MEDIA + REVIVE LOCAL PAPER.

I, hereby unconditionally release REVIVE RADIO & MEDIA + REVIVE LOCAL PAPER and its representatives from any and all claims and demands arising out of the activities authorized under the terms of this agreement.

By submitting the form below, I represent that I am at least 18 years of age, I have read the foregoing agreement and am familiar with all of the terms and conditions thereof and I consent to its execution. I agree that I will not revoke or disaffirm the foregoing agreement at any time.

Minors please have your parent and or guardian complete the form on your behalf and annotate the Minor’s details in the ‘Other details’ section.