Fill and Sign the Use Name School Form

Waiver, Release and Authorization to Use Name of Minor In Book to be Published as Part of School Project Agreement executed on _____________________________ (date) , by ____________________________ (Name of Minor) and the Guardian(s) of ____________________________ (Name of Minor) of _______________________________ ____________________________________________________________________________ (street address, city, county, state, zip code), both ______________________________ (Name of Minor) and Guardian(s) being jointly and severally referred to herein as Releasors , in favor of ______________________________________________________ (Name of School) of __________________________________________________________________________ ______________________________________ (street address, city, county, state, zip code) herein referred to as School . Whereas, _____________________________ (Name of Class) at School 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 the Book deals with, particularly why the name of minor is being used and is necessary for the Book) ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ________________________________________________________________________; and Whereas, ______________________________ (Name of Class) at School has used or desires to use the name of ___________________________ (Name of Minor) in said Book ; Now, therefore, for good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, Releasors , hereby expressly releases School , its administration, the publisher of the Book, the students of _______________________________ (Name of Class) , and the teacher of _______________________________ (Name of Class), said School , its administration, the publisher of the Book, the students of _______________________________ (Name of Class), and the teacher of ________________________________ (Name of Class) , being hereinafter jointly and severally called Releasees , from all liability for claims and/or demands arising out of the use of the names of Releasors in Book, including, but not limited to, libel, slander, invasion of privacy or any other claim based on use of the name of Releasors in said Book. Releasors hereby authorizes Releasees to use the name of Releasors in Releasees’ discretion, and to incorporate the name of Releasors into said Book in Releasees’ discretion, and to use any information that Releasors have provided in any way to Releasees 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 names of Releasors in the writing, making or the publication of said Book. 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 Minor) By: ___________________________________ ___________________________________ Signature of Father as Legal Guardian Signature of Minor ___________________________ _____________________________ (Printed or typed name) (Printed or typed name) _______________________________ (N ame of Child) By: _______________________________________ Signature of Mother as Legal Guardian _____________________________ (Printed or typed name)