2022-23 Media Release form

I GRANT my permission for 5th Element Center for Dance to use my child to be filmed, video taped, and/or photographed for public relations, public, marketing and instructional purposes. I understand that my child’s photo or other visual images may be used and/or reproduced in a newspaper, film, social media or video tape for public viewing. The photos and/or videos may be used by 5th Element Center for Dance in subsequent years.

I agree that 5th Element Center for Dance has complete ownership of such media including the entire copyright, and may use for any purpose consistent with the mission of 5th Element Center for Dance and ONLY 5th Element Center for Dance. I also understand that photographs or videos of my child WILL NOT be used for commercial purposes without my express permission.

By my agreement below, I agree to release and hold harmless 5th Element Center for Dance, its members, trustees, officers, contractors, volunteers and employees from and against any and all claims, demands, actions, complaints, suits or other forms of liability that shall arise out of or for by any reason of, or be caused by the use of my child’s name, photograph, video, creative works including: social media, television, radio, print or digital medium. 

It is further understood and I do agree that no monies or other consideration in any form, including reimbursement for any expenses incurred by me or my child, will become due to me, my child, our heirs, agents, or assigns at any time because of my child’s participation in any of the above activities or the above-described use of my child’s name, photograph, video, creative works including: social media, television, radio, print or digital medium or likeness. 

I also acknowledge that said child will not receive any compensation for the use of any photograph, video, creative works including: social media, television, radio, print or digital medium or likeness.

I understand that I may cancel my consent by providing written notice to 5th Element Center for Dance.