Seed Media Camp Release Form First and Last Name of Actor/Actress or Camp Participant * How Old Are You? * Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Phone Number APPEARANCE RELEASE & WAIVER OF LIABILITY (Read Fully and Sign) ADDRESS: PO BOX 3022 VALDEZ, AK 99686 PHONE: 907-200-2012 SEED MEDIA CAMP APPEARANCE RELEASE & WAIVER OF LIABILITY Primary and intended use(s) of photos/video: Seed Media LLC intends to use photos/video in Seed Media LLC advertising and promotional purposes. I hereby grant Seed Media the absolute right and permission to copyright and/or publish images captured through video, photo, or digital camera, of which I may be included in whole or part, for news release, art, advertising, trade, or any other lawful purpose whatsoever. I hereby waive any right that I may have to inspect and/or approve the finished product or the advertising copy that may be used in connection therewith, or the use to which it may be applied. I hereby release, discharge, and agree to save Seed Media LLC from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composition form, whether intentional or otherwise, that may occur or be produced in the making of said images, or in any processing tending towards the completion of the finished product. As lawful consideration for me or my minor child being permitted to participate in Seed Media Camps, I agree that neither I and/or my minor child will make a claim against, sue, attach the property of, or prosecute Seed Media LLC, Seed Media LLC employees, Fairbanks Wellness Coalition, or contractors for damages for death, personal injury, or property damage which I and/or my minor child may sustain as a result of participation in media camp activities. This release is intended to discharge in advance Seed Media Camp, and Seed Media LLC employees, Fairbanks Wellness Coalition, and contractors, from and against any and all liability, including for negligent actions, arising out of or connected in any way with my or my minor child’s participation in media camp, except for liability that may arise out of willful or wanton misconduct of Seed Media Camp. I understand that injuries or outcomes may arise from my own or others' negligence and conditions related to the Seed Media Camp location(s). Nonetheless, I assume all related risks, both known or unknown to me, of my participation in this Seed Media Camp. I FURTHER UNDERSTAND THAT SEED MEDIA CAMP REQUIRES OUTDOOR PHYSICAL ACTIVITY INCLUDING WALKING, CLIMBING, CRAWLING, CARRYING EQUIPMENT, AND OTHER STRENUOUS ACTIVITIES ASSOCIATED WITH LOCATION FILM PRODUCTION, THAT OCCASIONALLY CAN CAUSE PERSONAL INJURY, ILLNESS, PROPERTY DAMAGE, OR DEATH. I UNDERSTAND DRONE OPERATIONS WILL BE APART OF THE PRODUCTION PROCESS AND MAY FLY AROUND OR OVER HEAD. KNOWING THE RISKS OF PARTICIPATION, NEVERTHELESS, I HEREBY AGREE THAT I OR MY MINOR CHILD AND I ASSUME THOSE RISKS AND RELEASE AND HOLD HARMLESS SEED MEDIA CAMP, AND AGENTS, EMPLOYEES AND CONTRACTORS WHO (THROUGH NEGLIGENCE OR CARELESSNESS) MIGHT OTHERWISE BE LIABLE TO ME, AND/OR MY MINOR CHILD (OR OUR HEIRS OR ASSIGNS) FOR DAMAGES. I attest that I am eighteen (18) years old or older and that my child is physically fit and has no known medical conditions which prohibit participation in physical activity or film production. My child and I agree to follow all laws, rules, and guidelines regulating the conduct of film camp. I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY FOR MYSELF AND/OR MY CHILD AND A CONTRACT BETWEEN MYSELF, AND/OR MY CHILD AND SEED MEDIA LLC, FAIRBANKS WELLNESS COALITION AND THEIR AGENTS, ASSIGNS, AND EMPLOYEES, AND I HAVE SIGNED IT OF MY OWN FREE WILL. Signature (If under 18 a parent or guardian must sign) * signature keyboard Clear Date * Parent or Guardian Name reCAPTCHA If you are human, leave this field blank.