This document is a consent form for a 2017 calendar contest hosted by Heritage Life Story Funeral Homes. It gives the funeral home permission to use and reproduce any submitted photographs in print or electronic formats to promote the current and future calendars or for publicity purposes without additional compensation beyond the initial prize. The form requires contact information and a signature from participants acknowledging they understand the terms.
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2017 calendar contest photo release form
1. Heritage Life Story Funeral Homes
Grand Rapids Life Calendar
2017 Calendar Contest
Date: December 9, 2016
I hereby consent to and authorize the use and reproduction, in print or electronic format by Heritage Life
Story Funeral Homes or anyone authorized by Heritage Life Story Funeral Homes, of any and all
photographs selected for the Heritage Life Story Funeral Homes Grand Rapids Life Calendar 2017
Calendar Contest. The selected photos can / may be used for the promotion of the current and
subsequent calendars, or any publicity purpose without further compensation beyond the initial prize for
the selected photo(s).
I hereby acknowledge that I am 18 years of age or older and have read and understood the terms of this
release.
Name: ________________________________________
Signature: ________________________________________
Email: ________________________________________
Phone: ________________________________________
Address: ________________________________________
________________________________________
Complete ONLY if photographer is a minor
I hereby acknowledge that I am under 18 years of age and have the consent of the parent / guardian who
has read and understands the terms of this release.
Name of Minor: ________________________________________
Name of Parent / Guardian ________________________________________
Signature of Parent / Guardian: ________________________________________
Phone: ________________________________________
Email: ________________________________________
Address: ________________________________________
________________________________________