Form 4: Consent and Release

Applicant's First Name

Applicant's Last Name

Parent or Guardian First Name

Parent or Guardian Last Name

Parent/Guardian Email

Read the following paragraph then acknowledge and provide your electronic signature in the next section.

I hereby expressly grant to the X-Ring Rangers Junior Air Rifle Club and the American Legion Department of Alabama and their volunteers and employees, agents and assigns, the right to film, videotape, or photograph me and use my picture, silhouette and other reproductions of my physical likeness (as the same may appear in any still camera photograph and/or motion picture file and/or interactive media/internet), in and in connection with the exhibition theatrically on television, or otherwise. I further understand there will be no monetary compensation paid to me for said filming and any promotional materials, which may be derived from the same.

I have read this document and discussed it with my parents or guardians and freely enter this contract. (Check the box to acknowledge this statement.)

Applicant Signature

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Parent/Guardian Signature

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Parent/Guardian Affirmation

I, the undersigned, hereby warrant that I am the parent or guardian of the minor listed in Section 1 of this form and have full authority to authorize the above release which I have read and approved. (Check the box to acknowledge this statement.)

I hereby release the X-Ring Rangers Junior Air Rifle Club and The American Legion Department of Alabama, and their volunteers and employees, and their respective licensees, successors and assigns, from and against all liability arising out of the releaser's picture, silhouette and other reproductions of his/her physical likeness in connection with any print, film, interactive media/internet or videotape advertisement or other promotional media. (Check the box to acknowledge this statement.)

Parent/Guardian Signature

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Typed Full Name of Parent/Guardian

Form 4: Consent and Release

Applicant's First Name

Applicant's Last Name

Parent or Guardian First Name

Parent or Guardian Last Name

Parent/Guardian Email

Read the following paragraph then acknowledge and provide your electronic signature in the next section.

I have read this document and discussed it with my parents or guardians and freely enter this contract. (Check the box to acknowledge this statement.)

Applicant Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Parent/Guardian Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Parent/Guardian Affirmation

Parent/Guardian Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Typed Full Name of Parent/Guardian