8/3/2019 Z Photo Release Consent
1/1
Photo Release Consent Form
Agreement for Use of Images and Likeness in Z Studio
Products
InstructionsA signed release is required rom all participants
appearing in any photographs and/or videos taken by Z Studio
instructors,
employees or their agents. In the case o minors, the parent or
guardian must sign this release orm. This applies to all
pictures/
videos taken at any special event or classes at the studio.
Completed orms are maintained at the studio.
Photograph and Video Copyright ReleaseI hereby grant permission
to Z Studio to make visual and/or audio recordings and still images
o mysel and/or any minor under
my control at the time o the recording. I also grant permission
to Z Studio to use my photographic, video graphic, and/or
audioimage and/or likeness and/or any minors photographic, video
graphic, and/or audio image and/or likeness who is under my
control at the time o the recording, in ocial Z Studio
publications, displays, on the Internet and its World Wide Web Site
without
any consideration. These images are or public domain use unless
specifc restrictions are noted below. The image will be
credited
to Z Studio unless otherwise noted below.
Therefore, I agree to indemnify and hold harmless from any
claims the following: Z Studio
Lisa Ziebell
All employees, agents or independent ftness instructors o Z
Studio
I agree to the above full copyright release
____________________________________________________________________Signature
Special Agreement Instructions (purchase information, usage
restrictions, ect.): ________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Name: (Adult or Guardian)
_____________________________________________________________________________________
Name: (Minor)
______________________________________________________________________________________________
Address:
__________________________________________________________________________________________________
City State Zip
Phone: ________________________________________
Signature:
______________________________________________________________________
Date: _____________________
Studio
Dance Fitness
330 East Third Street
Winona, MN 55987
(507) 429-5952
