Professional Documents
Culture Documents
PLEASE PRINT
For good and valuable consideration, the receipt and sufficiency of which is
hereby acknowledged, I, ___________________________________, custodial
parent and/or legal guardian of (child)____________________________________ (the
“Child”), hereby grant to Newsday LLC and its parents, affiliated companies,
promotional agencies, advertisers, suppliers, directors, officers, agents, affiliates,
partners, licensees, and employees, and each of their respective heirs, legal
representatives, successors, and assigns (collectively, the “Releasees”), jointly and
severally, the irrevocable and perpetual right and license to use (a) the Child’s name,
image, voice, likeness, identity, and biographical information (“Likeness”) and (b)
each video and photograph created/taken by the Child and provided to Newsday
(“Content”), for potential publication/display in the Releasee’s respective publications
and programs including, but not limited to, in print publications (such as Newsday), on
websites (such as newsday.com), and in associated mobile and tablet applications,
and for advertising, commercial or promotional purposes in connection with such
publications/programs, in any medium now known or hereinafter invented,
determined in the sole discretion of the Releasees, without additional compensation
to us.
____________________________________
Printed Name of Parent or Guardian Name of Child
____________________________________ _____________________
Signature of Parent or Guardian Date
____________________________________ _____________________
Address Phone-daytime
____________________________________ ______________________
Parent’s E-mail Child’s E-mail (optional)