Fill and Sign the Consent About Form

Consent and Release of Parent to Display of Child's Artwork in Book with Limited Information About Child Agreement executed on ____________________ (date) , by ___________________ _____________________ (Name of Releasors) , who are the parents and/or guardians of _________________________ (Name of Child) of ___________________________________ _______________________________________ (street address, city, state, zip code) , said parents and/or guardians being jointly and severally referred to herein as Releasors, in favor of ___________________________ (Name of Author) of _______________________________ ____________________________________________ (street address, city, state, zip code) herein referred to as Author and __________________________ (Name of Publisher) , a corporation organized and existing under the laws of the state of ___________________, with its principal office located at _____________________________________________________ ____________________ (street address, city, county, state, zip code) , referred to herein as Publisher . Said Publisher and Author , including their agents and employees, are jointly and severally referred to herein as Releasees . _______________________ (Name of Child) is hereinafter referred to as the Child or Child . Whereas, Author is writing or has written a book entitled or to be entitled ___________ ____________________ (name of book) , hereinafter called Book ; and Whereas, said Book is or shall be an account of (briefly describe what Book deals with, particularly why the artwork of Child is being used and is necessary for the Book) ____________________________________________________________________________ ________________________________________________________________________; and Whereas, Author has used or desires to use certain artwork of Child and the first name, age and grade in school of Child in said Book ; Now, therefore, for and in consideration of Ten Dollars ($10.00) cash in hand this day paid, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, Releasors, being of lawful age, hereby expressly release Releasees from all liability for claims and/or demands arising out of the use of the Child’s said artwork and the first name, age and grade in school of Child in Book. This release includes, but is not limited to, libel, slander, invasion of privacy or any other claim based on the use of the Child’s artwork and the first name, age and grade in school of said Child in said Book. Releasors hereby further authorizes Releasees to use Child’s artwork and the first name, age and grade in school of said Child in Releasees’ discretion, in connection with the preparation and/or publication of said Book and in the promotion or advertising relating to the preparation and/or publication of said Book. Releasors further agree to indemnify and save Releasees harmless from any and all claims and liability for damages, losses or expenses of any sort arising from use of the Child’s artwork and the first name, age and grade in school of said Child in said Book and promotional material Releasors warrant and agree that they have read and understand the contents hereof, and that they have the right and authority to execute this waiver, release and indemnification. In witness whereof, the parties have executed this Agreement as of the date and year first above written. _______________________________ (N ame of Child) By: ___________________________________ _________________________________ Signature of Father as Legal Guardian Signature of Father as Releasor _____________________________ ___________________________ (Printed or typed name) (Printed or typed name) ________________________________ (N ame of Child) By: ___________________________________ _____________________________ Signature of Mother as Legal Guardian Signature of Mother as Releasor __________________________ _________________________ (Printed or typed name) (Printed or typed name)