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Form 4 of 4

Photograph and Social Media Release
Kansas State School for the Blind
I hereby execute this release on behalf of myself and my child for the benefit of the Kansas State School for the Blind (hereafter known as “KSSB”), its successors, assigns, partners, shareholders, affiliated companies or entities, employees, agents, and representatives, and those acting under KSSB’s permission or on KSSB’s authority.
I hereby irrevocably authorize KSSB to copyright, use, adopt for trademark purposes, exhibit, and/or publish pictures, portraits, reproductions, and likenesses of my Child in connection with therapy intervention, regardless of the form or media thereof, including, but not limited to: photographs, video, posted signs, labels, brochures, computerized or digital reproduction for training or other purposes, and television.
I hereby irrevocably authorize KSSB to copyright, use, adopt for trademark purposes, exhibit, and/or publish pictures, portraits, reproductions, and likenesses of my Child in connection with therapy intervention, on any/all social media platforms, including but not limited to: press releases, Facebook, Twitter, Instagram, and any other social media platform deemed appropriate. I understand that these social media postings will be public images until I request in writing to have them removed from any/all platforms. I further understand that these images can be copied and transmitted by others connected to any social media site without KSSB’s knowledge and irrevocably release and discharge KSSB from any and all claims listed in the following paragraph.
I irrevocably release and discharge KSSB, on behalf of me and my Child, from any and all claims for defamation, libel, slander, invasion of the right of privacy, invasion of the right of publicity, misappropriates, copyright and trademark infringement, or any other claim based on use, exhibition, misappropriations, copyright and trademark infringement, or any or claim based on exhibition, publication, reproduction or any sort, display, or distribution or any item or material described or referenced herein. I further agree to indemnify and hold KSSB harmless against any such claim for damages, compensation or otherwise on the part of the child or the heirs or representatives thereof and to reimburse or make good any loss, damages, costs, or attorneys’ fees that KSSB may incur in any litigation arises on account of claims by the Child or anyone on behalf of the Child thereof.
I HAVE READ AND FULLY UNDERSTAND ALL OF THE TERMS OF THIS RELEASE AND I EXECUTE IT VOLUNTARILY.(Required)
Child's Name(Required)
Parent/Guardian's Name(Required)
Date(Required)
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