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Photograph Release Form

I hereby grant Quarter Midgets of America ("QMA") permission to use my photograph(s) (the “Photograph”) and/or caption(s) (the “Caption”) (collectively, the “Submission”) as part of the QMA’s website (the “Website”) and in any of its publications, without payment or any other consideration.

I understand and agree that these materials will become the property of QMA and will not be returned. I also understand that my Submission may or may not be displayed on the Website, at the sole discretion of the Website Administrators.

I understand that this consent is voluntary and may be revoked at any time. You have the right to revoke your consent to future use of your Submission at any time by contacting us at the address below. Please be sure to provide us with a way of identifying the Photograph/Caption concerned. Your name and this form will be kept and used to identify your Submission for removal should you wish to revoke your consent and to identify you publicly on the Website as the photographer should your Photograph be selected to be displayed on the Website.

I hereby represent and warrant that the Photograph does not contain any identifiable individuals and that no individuals other than myself or the minors to which I am legal guardian are referred to in the Caption.

I hereby irrevocably authorize QMA to edit, alter, copy, exhibit, publish or distribute this Submission for the purposes of publicizing Quarter Midgets of America’s programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy. Additionally, I waive any right to royalties or other compensation arising or related to the use of the Submission.

I hereby represent and warrant that I am the photographer of the Photograph and the author of the Caption, that I have all rights, including all intellectual property rights, to my Submission and that no rights of third parties have or will be infringed by the use of my Submission to QMA and/or the displaying of my Submission on the Website.

I acknowledge that QMA has no control over, and is not responsible for, any use or misuse including, but not limited to, any alteration, modification, reuse or distortion of my Submission that may occur or be caused by third parties. QMA will not be monitoring and has no control over third parties’ use or misuse of my Submission displayed on the Website.

I hereby hold harmless, release and forever discharge QMA from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I am at least 21 years of age and competent to contract in my own name. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.

I also certify that the electronic signature entered below is that of the person so named and that it represents voluntary consent to be bound to the terms of this document.
An electronic signature is a legal concept for using an electronic symbol to represent a person's volitional consent to be bound to the terms of a document.


Please use your QMA Member number below to identify your photo. If your member number  is 1234567 then name the photo 1234567.jpg (or .gif as appropriate.)
E-mail all photos to webmaster@quartermidgets.org
 


(Electronic Signature)

 (Date)
 

If the person signing is under age 21, there must be consent by a parent or guardian, as follows:

I hereby certify that I am the parent or guardian of  , named above, and do hereby give my consent without reservation to the foregoing on behalf of this person.

 


(Parent/Guardian’s Signature)

(Date)
   


(Email address of person submitting this release)


(QMA Member Number)
 

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