Authorization and Consent Form - Part 2

I hereby hold harmless and release and forever discharge The Foundation, its officers, employees and agents, either in their individual capacities or by reason of their relationship to The Foundation and its successors, from all claims and demands whatsoever that I or any other persons acting on my behalf or on the behalf of my estate have or may have against The Foundation or any or all of the above-mentioned persons or their successors by reason of the above-mentioned grant of permission.

In this agreement, the terms “photograph” and “record” shall mean motion picture or still photography in any format, as well as videotape, videodisc, audiotape and any other mechanical or electronic means of recording and reproducing images and sound.




Date: ______________________

Time: ______________________


___________________________
Signature (If signed by other than subject, indicate relationship)
__________________________
Printed Name
Address____________________

Witness: ____________________


___________________________

___________________________