Hei Charitable Foundation Grant Outcomes Report (Page 4 of 4) in pdf

HEI Charitable Foundation

Photo Release Form

P.O. Box 730

(Minors)

Honolulu, HI 96808-0730

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PHOTO/VIDEO/RECORDING RELEASE

AND AUTHORIZATION FOR MINORS

As the parent or legal guardian of ______________________________________(enter minor’s name),

a minor (hereinafter “Minor”), I hereby consent to and authorize the HEI Charitable Foundation (the

“Foundation”), and anyone acting on its behalf, to photograph Minor, record video and visual images of

Minor, and record Minor’s voice on or about ________________ (enter date) (“visual and verbal

recordings”). I further consent to and authorize the Foundation and its agents to use, in its sole

discretion, such visual and verbal recordings and Minor’s name, and any other written or oral statements

Minor may provide relating to the Foundation’s business and programs, including but not limited to

_______________________________________ (enter project name), for news, media, advertising,

publicity, commercial, educational or other internal or external purposes relating to Foundation’s

business and programs. The consent given herein covers the Foundation’s use of such visual and

verbal recordings, either singularly or in conjunction with other photographs, videos, statements, sound

effects, or recordings from other projects.

I further authorize Foundation to reproduce, copy and publish such visual and verbal recordings. The

same may by exhibited in print media or on motion picture, television, internet or computer screens

throughout the world for the purposes listed above.

I, individually and on behalf of Minor, hereby release the Foundation, its affiliated companies (including

HEI) and their respective directors, officers, agents and employees, and anyone acting on the

Foundation’s behalf, of any liability for any claims arising out of or in any way related to the use as

described herein of the visual and verbal recordings or reproductions thereof.

Dated:____________________, 20__.

_____________________________

Signature

_____________________________

Printed Name

Thank you for taking the time to provide us photographs from your project. These images help us

explain the kinds of projects the Foundation seeks to support.

Hei Charitable Foundation Grant Outcomes Report Page 4