Agent Au Pair Photo and Video Release

Photo and Video Release

I grant Agent Au Pair, its representatives, and employees the right to take photographs/videos of me and/or my child. I authorize Agent Au Pair, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Agent Au Pair may use such photographs of me/my child with or without identifying by name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. There is no monetary compensation for the use of the work.
Child's Name - add more as needed *
Country
U.S. State
*

I DO give permission for my child's image/photograph or work to be used as described above, WITH OR WITHOUT name and other identifying information. We are willing to release this into the public domain and understand that no monetary compensation will be given for the use of the materials. I DO give permission for my child's image/photograph or work to be used as described above, WITHOUT name or other identifying information. We are willing to release this into the public domain and understand that no monetary compensation will be given for the use of the materials. I DO NOT give permission for my child's image/photograph or work to be used as described above.
Parent / Guardian Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
example@example.com
Phone Number *
Parent / Guardian Signature *

Clear
Date *

Month Day Year
Date
Should be Empty: