Please read the media release below.

I, or as parent or legal guardian of the below-named child (the “Child”) and for good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, grant to Crime Stoppers of Houston, FBI Houston Citizens Academy Alumni Association (CAAA), its partners in the #UnitedNotDivided initiative, and its licensees, assigns and successors in interest all right, title and interest, throughout the world and in perpetuity, in and to my or the Child’s performance, appearance, name, voice and the results and proceed thereof relating to my or the Child’s entry video for the #UnitedNotDivided PSA video contest (the “Video”), including without limitation photographs, videotapes, other media material and sound recordings of myself or the Child that Crime Stoppers of Houston, FBI Houston CAAA, licensees, and its partners in the #UnitedNotDivided initiative, has developed or will develop.

1. I authorize Crime Stoppers of Houston, FBI Houston CAAA, licensees, and its partners in the #UnitedNotDivided initiative (i) to edit the submission, and to include it with other performances and with sound effects, special effects and music; (ii) to use the submission in the Video, or not, in Crime Stoppers of Houston, FBI Houston CAAA, licensees, and its partners in the #UnitedNotDivided initiative’s sole discretion; (iii) to use and license others to use the submission in any manner or media, including without limitation unrestricted use for purposes of publicity, advertising, fundraising and education; and (iv) to use my or the Child’s name, likeness, voice and biographic or other information in relation to the submission or for any other purpose.

2. I acknowledge Crime Stoppers of Houston, FBI Houston CAAA, licensees, and its partners in the #UnitedNotDivided initiative owns all rights to such photographs, videos, media material, sound recordings and any other content resulting from the submission (the “Media Content”), in its entirety, including without limitation the right to all intellectual property rights and extensions or renewals thereof, and I hereby waive any right I may have to inspect and/or approve the finished product in which the Media Content may be included.

3. I acknowledge any Media Content developed in connection with the submission may be used by Crime Stoppers of Houston, FBI Houston CAAA, licensees, and its partners in the #UnitedNotDivided initiative for any purpose, including but not limited to promoting the mission of the initiative.

4. I release and discharge Crime Stoppers of Houston, FBI Houston CAAA, licensees, and its partners in the #UnitedNotDivided initiative, its employees, officers, directors, volunteers, licensees, designees, successors and assigns from any and all claims, actions and demands arising out of or relating to use of the Media Content, including but not limited to claims for invasion of privacy, defamation and libel.

ACKNOWLEDGED AND AGREED on the date set forth below:

I acknowledge and agree.

Date*

Child's Name*

First Last

Parent/Legal Guardian's Name*

First Last

Parent/Legal Guardian last 4 digits of TDL or State ID #.*

Phone*

Email*

Electronic Signature

I agree that submitting this form serves as my electronic signature.*

Click here if you agreee.