As parent and/or legal guardian of the child named below (the “Child”), I authorize my Child’s participation in the #UnitedNotDivided – Public Service Announcement (PSA) Video Contest (the “Contest’). For good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, on my own and my Child’s behalf, I grant Crime Stoppers of Houston, and the FBI Houston Citizens Academy Alumni Association (CAAA), licensees and its #UnitedNotDivided initiative partners, assigns and successors in interest a worldwide, perpetual, irrevocable license to use, license to others to use, reproduce, edit, prepare derivative works, publish, broadcast, distribute copies to the public, and perform and display publicly in any manner and for any purpose the video created and submitted by or on behalf of my Child for the Contest (the “Submission”). I further authorize Crime Stoppers of Houston, FBI Houston CAAA, licensees and its #UnitedNotDivided initiative partners to use the Child’s name, likeness, school name, grade level, or other biographic information provided in connection with the Submission.

On my own and my Child’s behalf, I certify that the Submission is the Child’s original work, to the best of my knowledge, and I have the authority to assign these rights to the Submission and content contained therein. I understand the Submission will not be returned, and Crime Stoppers of Houston, FBI Houston CAAA, and its partners in the #PreventToProtect initiative have no obligation to use the Submission.

I release and discharge Crime Stoppers of Houston, FBI Houston CAAA, 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 Submission. I acknowledge that neither I nor my Child expect remuneration or compensation from Crime Stoppers of Houston, FBI Houston CAAA, and its partners in #UnitedNotDivided, or any person or entity for the right and permission to use the Submission, as I grant such right and permission because of my desire to help Crime Stoppers of Houston, FBI Houston CAAA, and its partners in the #UnitedNotDivided initiative in its mission to help raise awareness about the consequences of making hoax threats.

I represent my Child and I have the right and authority to enter into this Authorization and Release and that the rights granted herein will not conflict with or violate any commitment or understanding I have with any other person or entity and have read this document and fully understand its content.

My child and I have read, and will abide by the Official Rules and Regulations for this contest. I also agree that submitting this form serves as my electronic signature.