Talent Release

Name

This field is for validation purposes and should be left unchanged.

Complete form in its entirety.

Name*

First Last

DOB (date of birth)*

This field is hidden when viewing the form

Permission & Confidentiality

I certify that this information is true and complete.

Name of Parent or Guardian*

First Last

Email*

Cell Phone*

Address*

Street Address City State ZIP Code

Release & Liability Waiver

Talent authorizes for no compensation, The Scoring Factory to: 1) Photograph Talent and record his/her voice and likeness for the purpose of any video, show, commercial, social media post or similar, whether by film, videotape, digitally or otherwise. 2) Make copies of the photographs and recordings so made. 3) Use Talent’s name and likeness for the purposes of entertainment, education, promotion or advertising of the sale or trading in the photographs, recordings and any copies so made. Talent understands the master footage and data remain the property of the The Scoring Factory and, unless otherwise stated, that there will be no restrictions on the number of times that Talent’s name and likeness may be used. Also, unless otherwise stated, there will be no restrictions to the geographical distribution of Production. Talent understands the terms described in this contract. He/she is over 18 years of age and has the authority to sign this contract and grant Producer the rights given under this contract and/or his/her parent or legal guardian has signed on their behalf. The undersigned, being an adult, parent or legal guardian of the Talent, does hereby affirm that the Talent is in good health and free from any illness, disability or condition requiring regular medication other than those which have been disclosed and approved. The undersigned hereby grants permission to The Scoring Factory for use of pictures, images and video taken at camps, clinics, practices, games and workouts which may be used for promotional purposes. In the event of accident or injury requiring immediate emergency treatment by professional medical personnel, the undersigned hereby gives consent to The Scoring Factory staff to procure any medical treatment deemed advisable on behalf of the Talent. The undersigned warrants that the Talent is fit to participate in physical activity and expressly represents the undersigned as the financially responsible party with regard to any and all medical costs, charges or fees incurred or resulting from the treatment of any and all illness or accident while under direct supervision of The Scoring Factory staff. The undersigned hereby releases The Scoring Factory, all facilities, all coaches and all staff members from any and all financial and legal liability associated with and/or arising from injuries or illness suffered by the Talent during participation in or with The Scoring Factory. The undersigned acknowledges that he/she has read and understands this release and liability waiver and agrees to waive any rights, express or implied, under Pennsylvania and any State Law to recover any and all medical expenses from The Scoring Factory through court action, arbitration and/or any other legal means from within or outside the United States of America.

Acknowledgment*

I have read and agree to the terms. I certify that this information is true and complete to the best of my knowledge. I grant permission to The Scoring Factory to verify and share this information with members of their staff.

Type Name*

Date*

Additional Comments

Join our mailing list?

Yes, please!
Not at this time.

CAPTCHA