GENERAL MEDIA RELEASE
Blessed2Praise LLC
22 E. Main St #1013
Middletown, NY 10940
1-800-535-5474
Name:_______________________________________. Email:_________________________________________
I hereby grant Blessed2Praise LLC and its affiliates the absolute and irrevocable right and permission to use my likeness, voice and any other content submitted (such as testimonials, reviews, stories, comments, etc.), photographs and/or video taken of me alone or with others, to use, re-use, publish, and re-publish the same in whole or in part, individually or in conjunction with any other other media such as photographs or video, and in conjunction with any printed matter, or electronic matter, in any and all media now or hereafter known, and for any purpose whatsoever; and to use my name in conjunction therewith if Blessed2Praise LLC so chooses, for promotional, marketing, and advertising purposes, including but not limited to website publication, social media posts, email newsletters, and other promotional materials in any manner or medium throughout the world an unlimited number of times in perpetuity in advertising, trade, promotion, exhibition, or any other lawful purpose. I also acknowledge that Blessed2Praise LLC may edit, modify, or alter such content as necessary for promotional purposes.
I hereby release and discharge Blessed2Praise LLC from any and all claims and demands arising out of or in connection with the use of the permissions granted herein, including without limitation any and all claims for libel, invasion of privacy, or physical, spiritual or emotional distress. I understand that I will not receive any monetary compensation for the permissions I am granting herein, and I waive my right to approve the final use. I understand that I cannot withdraw my consent after I sign this form and that this consent, authorization and release shall also inure to the benefit of the heirs, legal representatives, licensees, and assigns of Blessed2Praise LLC.
I am of full age (18 years old) and have the right to contract in my own name. If I am not yet 18 years of age, a parent or guardian has authorized my signature. I have read the foregoing and fully understand the contents thereof. The release shall be binding upon me and my heirs, legal representatives, and assigns. I acknowledge that this Release shall be governed by the laws of the State of New York, USA.
Name (print): ______________________________________________________ Date:_______________________________
Legal Name (signature): _______________________________________________________________
E-mail: ______________________________________________
Phone:(______)___________________________
Witness Name (print): _______________________________________________ Date:________________________________
Witness (signature):_________________________________________________
Witness E-mail: ____________________________________________
Witness Phone:(______)___________________________
If the individual named above is under 18 years of age, please complete the following:
I am the parent or legal guardian of the individual named above, and I hereby sign this General Media Consent and Release on behalf of such individual in accordance with the statements above.
Name of minor (signature):___________________________________________________
Parent/Guardian Name (print):___________________________________________________ Date:_____________________
Parent/Guardian (signature): ____________________________________________________
Parent/Guardian E-mail: ____________________________________________
Phone:(______)___________________________