Halloween Portrait Project Halloween Portrait Project Release Form HOW TO GET YOUR PHOTO Please fill out the photo release for all individuals getting portraits made Show me a screenshot of the successful submission page before your photo is taken. Please be patient until it is your turn. Please have fun and get some when you are done! Please come back and pick up your photo next year! Happy Halloween!! Adult Name ( Signer)* First Last Minor(s) Name(s)*Add the names (First and Last) of all minors to be photographed in the same family. One name per line. If there are no minors please write N/AEmail* PhoneAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Costume(s)*Enter your costumes, one on each line. Please identify something unique about the costume(s) as sometimes I get multiples of costumes - it is helpful if you say something like, "Purple Bumblebee with pink shoes."Optional PhotoIf you want you can upload a quick photo of your costume so I know which people go with this form. Drop files here or Select files Accepted file types: jpg, jpeg, gif, png, Max. file size: 50 MB. Consent* I consent to the photo release*For valuable consideration, I hereby confer on Deborah Lykins the absolute and irrevocable right and permission with respect to the photographs that he/she has taken of me and/or my minor child(ren) in which we may be included with others: a) To copyright the same in Deborah Lykins’ name or any other name that she may select; b) To use, re-use, publish and re-publish the same in whole or in part, separately or in conjunction with other photographs, in any medium now or hereafter known, and for any purpose whatsoever, including (but not by way of limitation) illustration, promotion, advertising and trade, and; c) To use my name or my child’s name in connection therewith if he/she so decides. I hereby release and discharge Deborah Lykins from all and any claims and demands ensuing from or in connection with the use of the photographs, including any and all claims for libel and invasion of privacy. This authorization and release shall inure to the benefit of the legal representatives, licensees and assigns of photographer Deborah Lykins as well as the person(s) for whom he/she took the photographs. I hereby affirm that I am over the age of majority and have the right to contract in my own name. I have read the above authorization, release and agreement, prior to its execution; I fully understand the contents thereof. This agreement shall be binding upon me and my heirs, legal representatives and assigns. I represent that I am the [parent/guardian] of the named minor(s). For value received, I hereby consent to the foregoing on his/her behalf.Stay in Touch? Add me to newsletter list to stay informed about the Halloween Portrait Project Your info is private, I will never sell it or spam you, I promise!!