Public Service Announcement2020-2021 School YearActor Release Step 1 of 4 25% Please read the statement below. You must agree and grant permission to participate.*I, hereby grant permission to Crime Stoppers of Houston and the FBI Houston Citizens Academy Alumni Association (CAAA), licensees and its partners in the #STOPSEXTORTION initiative, the rights of use of my image, likeness, video and sound of my voice as recorded on audio or video tape. I understand that my image may be edited, copied, exhibited, published, or distributed and waive any right to inspect or approve the finished product. Photographic, audio, or video recording authorization includes the following: 1. I authorize Crime Stoppers of Houston and the FBI Houston CAAA, licensees, and its partners in the #STOPSEXTORTION 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 #STOPSEXTORTION 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 #STOPSEXTORTION 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 #STOPSEXTORTION initiative for any purpose, including but not limited to promoting the mission of the initiative. Page 1 of 2 (#STOPSEXTORTION - Actor Release) 4. I release and discharge Crime Stoppers of Houston, FBI Houston CAAA, licensees, and its partners in the #STOPSEXTORTION 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. 5. #STOPSEXTORTION Video Contest promotions (including, but not limited to, website, social media, print and email publications). Video recording may be shown during any and all Crime Stoppers of Houston, FBI Houston CAAA, its partners in the #STOPSEXTORTION initiative program events and collaborative projects. By signing this release, I understand that this permission signifies that photographic or video recordings may be electronically displayed via the Internet or in the public educational setting. By signing this form, I acknowledge that I completely and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for any purpose deemed appropriate by Crime Stoppers of Houston, FBI Houston CAAA, licensees, and its partners in the #STOPSEXTORTION initiative. I agree and grant permission. Actor InformationFull Legal Name of Actor:* First Last Is the actor a minor?*YesNoActors Date of Birth* Date Format: MM slash DD slash YYYY Parent/Legal Guardian Name* First Last Parent/Legal Guardian last four digits of TDL or State ID.*City/State of Residence*Phone*Email* Enter Email Confirm Email Team InformationSchool Name*Team Name*Teacher Sponsor Name* First Last Electronic SignatureAcknowledged and Agreed on the date set forth below.* Click here if you agree.