Urban Ministries, Inc. Photo/Media Release Agreement

For good and valuable consideration, receipt of which is hereby acknowledged, I hereby grant to Urban Ministries, Inc. (“Publisher”) and its licensees, successors, and assigns, permission to photograph and record me, which may include recording my likeness, voice, conversation, and sounds, as well as any performance of any musical composition(s), during and in connection with my appearance or performance for Publisher (any resulting recording(s) and/or photographs(s) collectively are referred to as “My Appearance”). I understand and agree that Publisher may edit, manipulate, size, or crop My Appearance as Publisher deems appropriate under the circumstances, and that My Appearance may be used and licensed by Publisher throughout the world, in any and all forms, media, and technologies with regard to all products, publications, promotions, advertising, and marketing materials as Publisher deems appropriate.  I acknowledge that Publisher shall be the exclusive copyright owner of My Appearance.  For purposes of clarity, I expressly waive any and all rights I may have in connection with My Appearance 

General description of My Appearance covered by this release:

I understand that no compensation and/or royalties shall be payable to me or my heirs, successors, or assigns for said use of My Appearance. I hereby warrant that My Appearance is original, does not infringe any copyright, and does not violate the rights of any third party.  

If signing on behalf of a minor, I hereby represent that I have the legal authority as the minor’s parent or legal guardian to enter into this release.

I, my heirs, guardians, legal representatives, executors, administrators, successors and assigns hereby forever release Publisher, its directors, agents, employees, licensees, successors, and assigns from any and all claims and liability in connection with any injury, illness, damage, loss or harm to me, or my property, however caused in connection with My Appearance.

My signature below shall evidence my agreement to and authorization of the terms stated herein.

Fill out the form below or Download Form (PDF), fill it out, and upload it to the UMI dropbox folder.

Agreed to and authorized by: