Nominee's Release Form - Cleveland 19 News Cleveland, OH

Nominee's Release Form

RELEASE FORM

I hereby give WOIO/WUAB, their legal representatives, employees, those for whom they are acting, and those acting with their permission, the right to copyright and use, reuse, broadcast and republish videotape recordings of me, including that in which I may be distorted in character or form, in conjunction with my own or fictitious name, on reproductions thereof in color or black and white, made through any media by WOIO/WUAB at their studio or elsewhere, for any purpose whatsoever.

I hereby waive the right to inspect or approve the finished videotape, sound track, advertising copy or printed matter that may be used in conjunction therewith or the eventual use that is might be applied.

I agree to save harmless WOIO/WUAB their representatives, employees, and any persons or corporations acting under their permission or authority, and any persons or corporations for whom they might be acting, including any firm publishing and/or distributing the finished product in whole or in part, from and against any liability as a result of any distortion, blurring, alteration, optical illusion or use in composite form, either intentionally or otherwise, that may occur or be produced in the taking, processing or reproduction of the finished product, its publication, distribution or broadcast of the same even should it subject me to ridicule, scandal, reproach, scorn or in dignity.

I hereby certify that I am competent to contract in my own name in so far as the above is concerned.

I have read the foregoing release, authorization and agreement before affixing my signature below and warrant that I fully understand the contents thereof.

                        TODAY'S DATE:_______________________

                        NAME: (print)____________________________________

                        SCHOOL________________________________________

                        ADDRESS: ______________________________________

                        CITY: ___________________________________________

                        STATE/ZIP: ______________________________________

                        PHONE NUMBER: ________________________________

                        SIGNATURE: _____________________________________

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