San Mateo Photo Waiver

Personal Image and Video Release Form

I hereby give my consent for Dragonfly Designs, LLC (or “Dragonfly Designs”) to use either my, or the undersigned stated minor’s: photograph, silhouette, likeness, recorded voice, performances, poses, acts, and appearances in its publications. This use includes but is not limited to Dragonfly Design’s website, advertisement video, unlimited distribution and any other reproduction. Dragonfly Designs promises to not identify my personal information in any way. Accordingly, I release myself from any expectation of confidentiality, and/or rights of publicity. Furthermore, I release all claims against Dragonfly Designs with respect to copyright ownership and publication including any claim for compensation related to use of such materials. I have read the foregoing and fully understand the meaning and effect thereof and, intending to be legally bound, I have signed this release. Failure to sign and return this document represents your intent to not be bound by these conditions.

Your Name*
Child's Name (if Applicable)
Relationship to Child (if applicable)
Date*
MM slash DD slash YYYY
Opt Out
DO NOT allow myself (or child applicable) to be photographed, videotaped and/or audio taped during activities
Signature*
Email
Consent
I agree to the privacy policy.
PERSONAL IMAGE AND VIDEO RELEASE. As a Participant, I hereby give my consent for Dragonfly Designs to use either my, or the Stated Minor’s photograph, silhouette, likeness, recorded voice, performances, poses, acts, and appearances in its publications. This use includes but is not limited to Dragonfly Design’s website, advertisement video, unlimited distribution and any other reproduction. Dragonfly Designs promises to not identify children in any way.

San Mateo Photo Waiver

Personal Image and Video Release Form

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