Photography and Video Release for Minor Child or Children
I hereby authorize Inner Explorer, Inc., hereafter referred to as “Company”, to publish
photographs and video taken on _________________ date of myself and/or the minor child or
children listed below, and our names and likenesses, for use in the Inner Explorer, Inc.’s print,
online and video-based marketing materials, as well as other Company publications.
I hereby release and hold harmless Inner Explorer, Inc. from any reasonable expectation of
privacy or confidentiality for myself and for the minor child and children listed below associated
with the images specified above. Further, I attest that I am the parent or legal guardian of the
child or children listed below and that I have full authority to consent and authorize Inner
Explorer, Inc. to use their likenesses and names.
I further acknowledge that participation is voluntary and that neither I, the minor child, nor
minor children will receive financial compensation of any type associated with the taking or
publication of these photographs or participation in company marketing materials or other
Company publications. I acknowledge and agree that publication of said photos confers no
rights of ownership or royalties whatsoever.
I hereby release Inner Explorer, Inc., its contractors, its employees and any third parties
involved in the creation or publication of Company publications, from liability for any claims by
me or any third party in connection with my participation or the participation of the minor
children listed below.
Authorization:
Printed Name: ___________________________________________
Signature: ____________________________________________Date: _________________
Street Address: _____________________________________________________
City: ____________________________________ State: ____________ Zip: _______________
Relationship to Child/Children: ____________________________________________________
Names and Ages of Minor Child/Children:
Name: ______________________________________________ Age: _____________
Name: ______________________________________________ Age: _____________
Name: ______________________________________________ Age: ____________
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