MS Photo and Video Release Form

photo/video release authorization

I hereby authorize Center Grove Ultimate Club, Inc. and its representatives to take photographs and/or video of me and my property in connection with CGUC approved events. I authorize the CGUC, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that the CGUC may use such photographs and videos of me with or without my name and for any lawful purpose including. but not limited to, publicity, illustration, advertising, and web content.

* Indicates required field

Player's Signature *

Date (mm/dd/yy) *

Parent's Signature *

Date (mm/dd/yy) *

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photo/video release authorization

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