___________________________________________
Name of Student
___________________________________________
School & Class
I, the undersigned, parent or guardian of the above named student, do hereby consent to the taking of photographs, movies or videotapes of my son/daughter by Cabot Creamery Cooperative in connection with the making of an informational video or their use in any and all media, including but not limited to the use on an internet web site. I also grant to Cabot Creamery Cooperative the right to edit and reuse said products for any and all educational purposes.
Further, I grant and release to Cabot Creamery Cooperative any and all rights, title and interest I or my son/daughter might have in said photographs, movies or video-tapes, finished picture, reproductions, copies or negatives of the same.
Further, I grant to Cabot Creamery Cooperative consent, except for use as an endorsement for any commercial product or service, to copyright, use and reuse reproductions, and simulations of my son’s/daughter’s likeness for all forms of publication, transmission and recording.
This consent is given in order to release Cabot Creamery Cooperative and its agents and employees from all claims, demands, liabilities whatsoever in connection with the above.
___________________________________________
Date
Parent/Guardian Name (print) and Signature
Student Name (print) and Signature
This form must accompany all photos sent to Cabot!
Calcium Crisis Challenge Coach
Cabot Creamery
One Home Farm Way
Montpelier, Vermont 05620
802-433-6102
coach@cabotcalciumchallenge.com