Child Photo Release Please enable JavaScript in your browser to complete this form.Delta Dental of Idaho is a not-for-profit corporation with a mission rooted in the power of oral health to enrich lives. Thank you for agreeing to work with Delta Dental of Idaho on the Project described below to help us further our mission. Please review this Release and Assignment. If you agree to the terms, complete the information under the signature block, sign and email this document or return a copy to the Delta Dental of Idaho Project Coordinator. Child/Participant Name *Project Description: Photograph for the website, presentations, social media, and other professional use cases. Effective Date: Feb 29, 2024 Project Coordinator: Sonja Deines, Director of Marketing and Communications Phone: 208-488-7707 Email: sdeines@deltadentalid.com I now, as of the Effective Date above, authorize Delta Dental of Idaho use my child’s image in all forms, media, and manner, including but not limited to film, audiotape, videotape, and digital media, other media, or print (electronic or text) (collectively “Recordings”). I acknowledge, understand, and agree that Delta Dental of Idaho may, in its sole discretion: 1. Edit these Recordings. 2. Create derivative works from such Recordings. 3. Use such Recordings in conjunction with other persons or recordings, in composite or adapted in character or form. 4. Use and distribute such Recordings in any format and in any manner of media whatsoever. Delta Dental of Idaho’s use of such Recordings shall be unrestricted for publicity, advertising, trade, promotion, exhibition, or any other lawful purposes, now and in the future, regardless of whether that purpose is known to me. I understand that Delta Dental of Idaho is not obligated to seek my review or approval before using the Recordings or finalizing the Project. My work in conjunction with this Project and any resulting Recordings is considered “work made for hire” under the Copyright Act of 1976, as amended. I, ON BEHALF OF MYSELF, AND MY PERSONAL REPRESENTATIVES, ASSIGNS, AND HEIRS, FOREVER DISCHARGE AND RELEASE DELTA DENTAL OF IDAHO, ITS AGENTS, EMPLOYEES, OFFICERS, DIRECTORS, SUCCESSORS, MEMBERS, AND ASSIGNS FROM ANY AND ALL LIABILITIES, CLAIMS, CAUSES OF ACTION, AND/OR DEMANDS ARISING OUT OF OR IN ANY WAY CONNECTED WITH MY WORK AND PARTICIPATION IN THE PROJECT AND/OR DELTA DENTAL OF IDAHO’S USE OF THE RECORDINGS. Delta Dental of Idaho exclusively owns all rights to these Recordings, including copyright, regardless of the form they are produced or used, and I waive all rights to royalties or other compensation arising from or related to use of the Recordings. By signing below, I warrant and agree that I have read and understand the contents of this Release and Assignment and that I have the legal right and authority to sign this Release and Assignment. Fill Parent or Legal Guardian Name for Signature: *Email: *Phone: *Submit