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Release for Media Recording
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Please complete the form below:
Client Information
Name
*
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
The Agreement
I do hereby consent and agree that Nicky Quick & Company, LLC, its employees, contractors, or agents have the right to take photographs, videotape, or digital recordings of me before, during, and immediately after the birth of my child and to use these in any and all media, now or hereafter known, and exclusively for the purpose of business marketing, social media updates, and website design. I further consent that my name and identity will not be revealed therein or by descriptive text or commentary. (Note: The client will have ultimate decision making privileges for all photos depicting sensitive or revealing images. Nicky Quick & Company, LLC will confer with the client and provide sample images to the client for all material to be used.)
I do hereby release to Nicky Quick & Company, LLC, its agents, contractors, and employees all rights to exhibit this work in print and electronic form publicly or privately. I understand that I share all rights, claims, or interest I may have to control the use of my identity or likeness in whatever media used with Nicky Quick & Company, LLC. (Note: The client will have ultimate decision making privileges for all photos depicting sensitive or revealing images. Nicky Quick & Company, LLC will confer with the client and provide sample images to the client for all material to be used.)
I understand that there will be no financial or other remuneration for recording me, either for initial or subsequent transmission or playback.
I understand that Nicky Quick & Company, LLC is not responsible for any expense or liability incurred as a result of my participation in this recording, including medical expenses due to any sickness or injury incurred as a result.
I represent that I am at least 18 years of age, have read and understand the foregoing statement, and am competent to execute this agreement.
I, the undersigned,
*
DO agree to the terms and provisions listed above
DO NOT agree to the terms and provisions listed above and do not consent to being photographed or recorded in any manner
Client Signature
Date
*
MM
DD
YYYY
Contract Agreement
*
I agree to sign this document via electronic signature and that by signing electronically, it serves as my actual hand-written signature on a legal document.
Electronic Signature
*
Thank you!
