Bay Port Festival Media Release Form

Production Title:    Bay Port Festival Royalty Contest

Production Date:    Ongoing

1. I, the undersigned, hereby authorize Bay Port Festival staff to photograph me. take motion pictures of me, take video footage of me, and/or make electronic sound recordings of me (herein referred to as photographic or electronic reproductions)

    2.    I authorize the use of any such photographic or electronic reproductions of me for any purpose, including, but not limited to educational, social, and other public media as may be deemed appropriate by Bay Port Festival Staff (I understand that I may be identifiable from such photographic or electronic reproduction)

Agreed and accepted by:

Print Name:__________________________________________________________

Address:__________________________________________________________________________________

City:__________________________    State:______    Zip:______________

Phone:________________________

Signature & Date

_______________________________________________________    Date___/____/____

I am signing this form as an individual:    Yes    No

I am signing this form as a representative of a group, and have full authority to grant release for this group:    Yes    No

Name of group:__________________________________________________________

PARENTAL CONSENT

I certify that I am the parent or guardian of the individual above,_________________, a minor under the age of eighteen years. I hereby agree to assume legal responsibility for his/her authorizations referred to in this General Media Release.

Signature of Applicant's Parent/Guardian:_________________________ Date___/___/___

Address of Parent/Guardian (if different)        Phone Number (if different)___________

__________________________________________

__________________________________________

__________________________________________
City                            State                      Zip Code