Form 125-343

Image Release Form

General

NOVA is photographing and/or videorecording and/or livestreaming the event in which you are participating and or attending.

By your presence in this area, you acknowledge that you have been informed that you may be photographed and/or recorded and/or livestreamed as part of the program/event.

Further, by your presence here, you grant your irrevocable permission for your likeness, mannerisms and voice to be included in the video program or other programs without compensation and/or credit, and for such programs to be exploited in any and all media worldwide in all perpetuity.

If you do not wish to be photographed, recorded or appear in the said program, please leave this immediate area or be aware of the cameras and avoid them.

Thank you for your cooperation.

First Name

Last Name

Are you under the age of 18?

Parent/Guardian Email Address

First Name	Last Name	Email	Under Age	Parent Email
Click on "Add To Cart" to add more entries.

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Signature

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Today's Date

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If under 18 years old, Parent or Guardian signature

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Today's Date

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Signature

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Today's Date

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If under 18 years old, Parent or Guardian signature

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Today's Date