Model Parental Consent Gideon Center Location Name*Name of Legal Guardian, "Parent"*Name of Minor Child, "Model"*I "Parent" hereby irrevocably grant permission Gideon Math & Reading, LLC (“Company”), its legal representatives, assigns, agents, and licensees to take and use photographs, videos, sound recordings, image, likeness, and voice of Model for all manner of advertising, trade, promotion, exhibition, or any other lawful purpose whatsoever and in any form or medium in conjunction with the furtherance of Company business. Model’s participation is strictly on a voluntary basis and no compensation is expected or will be received. In my capacity as parent/legal guardian of Model, I waive any right to inspect or approve the images or copies that may be used in connection therewith or the use to which the copies or images may be applied. In my capacity as parent/legal guardian of Model, I hereby release and agree to hold harmless Company, and its legal representatives, assigns, and those acting under its permission or authority, from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of the pictures, or in any processing tending toward the completion of the finished product. I understand that all right, title, and interest in the photographs, video, and sound recordings belong solely to Gideon Math & Reading, LLC in perpetuity. I understand and agree to the conditions set forth within this agreement. I acknowledge that I am fully aware of the contents of this release, and I am under no disability, duress, or undue influence at the time of the signing of this agreement.*Read the statement above, and check the box to agree if applicable. I, "Parent", agree with the above statement. Date MM slash DD slash YYYY Δ
