Please fill out this form for each adult person

[contact-form to=’’ subject=’Media Release Form Submitted’]

[contact-field label=’Name’ type=’name’ required=’1’/]

[contact-field label=’Address’ type=’textarea’ required=’1’/]

[contact-field label=’Phone’ type=’text’ required=’1’/]

[contact-field label=’Email’ type=’email’ required=’1’/]

[contact-field label=’Children%26#039;s names and ages’ type=’textarea’/]

By clicking submit, I, hereby grant permission to West Georgia Elves, Inc. to post my and/or my child’s story, photo, or other item, hereinafter referred to as “Materials,” I submit to and for the West Georgia Elves, Inc. Web site, Twitter account, and Facebook account, and other web / social media that the corporation participates in and/or publications, news, or media releases.

I hereby release you, your representative, employees, managers, members, officers, parent companies, subsidiaries, and directors, from all claims and demands arising out of or in connection with any use of said “Materials”, including, without limitation, all claims for invasion of privacy, infringement of my right of publicity, defamation and any other personal and/or property rights.

I acknowledge and agree that no sums whatsoever will be due to me as a result of the use and/or exploitation of the “Materials” or any rights therein.

I waive any right I may have to inspect or approve the images, their use, or any printed, video, or audio matter that may be used in connection therewith, and the images and any negatives are the sole property of West Georgia Elves, Inc.

I further acknowledge that if my child is under 18 years old and lacks the legal capacity to enter into binding agreements that I have the legal capacity to enter into this agreement on his/her behalf. Accordingly, I have read this Release and consent to my child’s inclusion in the Materials and will not contest the rights granted in this Release, and shall assist and support you in any and all legal proceeding for affirmation of this Agreement, should you choose to have a court of law affirm this Agreement.

I understand that in granting this, my last name, mailing address and other personal information will remain private.

I further attest that am over 18 years of age and am able to enter into this binding Agreement.