Recipient Model Release Form (Child)

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For and in consideration of my engagement as a model by Wigs For Kids, I hereby give my full permission to Wigs For Kids, its agents, successors, assigns, clients, recipients of its services and products, to use my name, image and voice in conjunction with the production, marketing, publicizing, promotion and sale in any medium; including electronic, print, and live communications of the program, project or organization publications.

I hereby waive any right to inspect or approve the finished photograph, video, advertising copy or printed matter that may be used in conjunction therewith or the eventual use that it might be applied.

I hereby release, discharge and agree to save harmless the photographer, his representatives, assigns, employees or any person or persons, corporation or corporations, acting under his permission or authority, or any person or persons, corporation or corporations, for whom he might be acting, including any firm publishing and/or distributing the finished product, in whole or in part, from and against any liability as a result of distortion, blurring alterations, optical illusion, or use in composite form, either intentionally or otherwise, that may occur or be produced in taking, processing or reproduction of the finished product, its publication or distribution of the same, even should the same subject me to ridicule, scandal, reproach, scorn or indignity.

I hereby warrant that I am over twenty-one years of age and competent to contract in my own name insofar as the above is concerned.

This consent shall be a continuing consent for this and related programs or projects that may evolve from it without any limitations or reservations whatsoever other than those so stated in this release.

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About Wigs For Kids

Wigs For Kids is a nonprofit organization that helps children experiencing hair loss stemming from chemotherapy, radiation therapy, alopecia, trichotillomania, burns, and other medical causes. Stylists and regular people just like you work together to give recipients the self-esteem and self-image they deserve.


24231 Center Ridge Road Westlake, OH 44145

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