LEGAL NAME OF MINOR *

First Name

Last Name

Phone of Parent/Guardian

The parent or guardian may be called to confirm authenticity.

(###)

###

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ADULT DECLARATION *

I hereby declare that I am the PARENT/GUARDIAN of the minor listed.

I hereby declare that I, the PARENT/GUARDIAN will complete the remainder of the form myself.

I am NOT the PARENT/GUARDIAN, therefore I cannot complete nor submit this release.

Do you trust us to use responsibly the pictures and/or video your child creates with us?

Your checking this release section is the same as signing. Signing is optional.

I APPROVE: I hereby give Nixon Studio Rental and its representatives irrevocable consent to use any images, videos, or sound recordings of me for all purposes, including advertising, without any approval rights. I release them from any liabilities related to image alterations and acknowledge this as our complete agreement.

I DECLINE to release any footage to NIXONSTUDIORENTAL at this time.

General Release of Liability *

You are not required to submit this section of our form, however not doing so will cancel your scheduled session. This section says basically you give up any and all rights to sue Nixon Studio Rental should anyone become injured before, during or after a session, including yourself or anyone attending invited by you or invited by anyone you invited, allowed to attend.

I AGREE: In consideration of valuable benefits received, I hereby release and discharge Nixon Studio Rental and all related parties from any claims or liabilities, present or future, related to any injuries or damages, personal or property-related, arising from or connected to Nixon Studio Rental. This agreement constitutes our entire contract and is binding on all parties, governed by Massachusetts law. I confirm my understanding of this release.

I DECLINE to release NIXON STUDIO RENTAL of any liability.

Parent/Guardian Birth Date *

ex. 08 20 1965

MM

DD

YYYY

Minor's Date of Birth *

MM

DD

YYYY