Media Release

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MEDIA RELEASE FORM

In consideration of my attendance at the Youth Social Entrepreneurship Summit, I hereby the Sundance Family Foundation (Foundation) and its partner organizations to record my name, likeness, image, voice and participation in and performance on film, tape or otherwise (content). I agree that the content may be edited and otherwise altered at the sole discretion of the Foundation and used in whole or in part for any and all broadcasting, audio/visual, and/or exhibition purposes in any manner or media, in perpetuity, throughout the world. I understand that I have no rights to the content or any benefits derived therefrom. I consent to the use of my name, likeness, voice and biographical material about me in connection with the promotion the Youth Social Entrepreneurship Summit and related activities. I represent that I have the right, capacity, and authority to enter into this agreement (the Agreement) and that my participation and performance and the rights I have granted in this Agreement will not conflict with or violate any commitment or understanding I have with any other person or entity. I agree to indemnify and hold harmless the Foundation and its partner organizations and against all claims, losses, expenses and liabilities of every kind including reasonable attorneys fees arising out of the inaccuracy or breach of any provision of this Agreement. I expressly release Foundation and its partner organization from any and all claims arising out of the use of the Content. This Agreement will in all respects be governed by and interpreted, construed and enforced in accordance with the laws of the State of Minnesota. This Agreement represents the entire understanding of the parties and may not be amended unless mutually agreed to by both parties in writing.

___________________________________________
PARTICIPANT SIGNATURE

_____________
DATE

___________________________________________
ADDRESS

______________________
CITY, STATE, ZIP

___________________________________________
E-MAIL ADDRESS

______________________
PHONE

I represent that I am the parent and/or guardian of the minor who has signed above or is the participant in the Youth Social Entrepreneurship Summit. I agree that we both shall be bound by this Agreement.

_____________________________________________________
PARENT/GUARDIAN

V2.040405

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