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Consent Form and Release for Minor Children
By my signature below, electronic or otherwise, I hereby consent to and authorize WHITEWATER PUBLICATIONS, INC., an Indiana corporation (hereinafter referred to as “Publisher”), its officers, directors, agents and employees acting within the scope of the publication and their respective scope of employment as the case may be, the unconditional right and authority to use my child’s name, likeness, image, voice, any and all attributes of his or her personality, and creative works which may be used in any form including, but without limitation: photographs, portraits, pictures, illustrations, digital images, digital recordings, video recordings, audio recordings, audio visual works, animations, broadcasts, works of art including without limitation crafts.

The consent I grant herein shall include any form of creative works, media or other embodiment, now known or unknown, including without limitation, any reproductions thereof, or all formats of computer readable media. Further, the use of my child’s name, likeness, image, voice, any and all attributes of his or her personality, and creative works, which may be featured, or included in whole or in part, may be made for any lawful purpose whatsoever, including without limitation to print, produce, publish, copy, display, perform, exhibit, transmit, broadcast, disseminate, market, advertise, sell, lease, license, transfer, modify, and create derivative works in any form, media, or embodiment, and for use on websites owned by Publisher. I hereby consent and authorize Publisher to use of any of the intellectual property rights that my child may possess, including without limitation, copyrights to any creative work of my child.

I hereby waive any right to inspect, examine, or approve any content contemplated herein for the stated purposes, or the use to which it may be applied. Further, I acknowledge that Publisher has the exclusive right and discretion in determining suitability for its purposes contemplated herein. Further, I hereby waive, release, discharge, and agree to indemnify and hold harmless Publisher and its officers, directors, employees and agents from any and all claims, demands, and causes of action that I, my child, or anyone else may bring as a result of the consents and authorizations granted herein.

It is further understood that no monies or other consideration in any form, including reimbursement for any expenses incurred by me or my child, will become due or otherwise payable to me, my child, our heirs, agents or assigns at any time because of my child’s participation in any activities of Publisher, or for any of the rights granted herein.

I represent and warrant that I am the parent or legal guardian of the minor child listed below. I hereby consent to the foregoing on his/her behalf.
Friday, March 31, 2023

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531 Main Street
Brookville, Indiana 47012
Office: (765) 647-4221
Fax: (765) 647-4811
Monday - Friday: 8 AM to 4 PM