Sca Model Release Form printable pdf download

SCA MODEL RELEASE FORM

I, (legal name)

, being known within the

Society for Creative Anachronism as (name)

, do hereby grant

permission to the SCA for the photograph of me taken by

to be used as follows (check all that apply, complete blanks as necessary):

OPTION #1 — RELEASE FOR ALL PHOTOGRAPHS

The SCA may publish any photograph taken of me in any SCA publication, including print, web and electronic.

I reserve the right to ask that any specific picture on the web or in electronic media to be removed.

PLEASE STOP: If you checked Option #1, do not check any of the Options below.

OTHER OPTIONS — GRANTS OF USE

The SCA may (check all that apply):

publish my photo once in an issue of

;

publish my photo no more than

times in the above publication;

publish my photo with the article entitled

;

publish my photo in any re-print of the above publication including electronic form;

publish my photo on a SCA web site for

;

publish my photo with any article or as a stand-alone picture in any SCA publication, including print, web

and electronic.

I affirm and agree:

1. that this agreement shall be binding upon me and my heirs, legal representatives and assigns.

2. that I am over the age of majority and at least eighteen years of age and legally able to sign this release on

my own behalf. If I am not, the name and signature of my legal guardian appear below as authorization

for this use.

3. to indemnify and hold harmless the SCA in the event any claim is brought against the SCA by any person

claiming that this Release is not valid and enforceable or that I did not have lawful authority to grant the

above permission and rights to the SCA.

I have read the above Release prior to its execution and fully understand the contents and consequences thereof.

SIGNATURE

DATE

E-MAIL ADDRESS

MAILING ADDRESS

**LEGAL GUARDIAN NAME (Please Print)

LEGAL GUARDIAN SIGNATURE

DATE

**If I am executing this Release as a Parent or Guardian, I consent to the use of my child’ s image or photograph as set

out above, and I agree that if despite the Release, my child makes a claim against the SCA, I will hold harmless and

indemnify the SCA for any damages it may incur as a result of said claim.

PM NEW 8/10

Sca Model Release Form