I, {name} (“Releasor”) with a mailing address of
- {address} , grant permission and consent to:
Empower Muay Thai for the use of photos taken by employees of or agents for Empower Muay Thai for presentation under any legal condition, including but not limited to publicity, copyright purposes, illustration, advertising, and web content:
- I understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.
Revocation
- I understand that with my authorization below the photograph(s) may never be revoked.
Releasor understands and agrees to the aforementioned terms and conditions.
Releasor’s Signature: - Name of the member or guardian signing the document
Print Name:
