Turner-Fairbank Highway Research Center R&D Communication Reference Guide

APPENDIX N. FHWA MULTIMEDIA CHILD MODEL RELEASE FORM

-Multimedia Child Model Release Form-
US Department of Transportation
Federal Highway Administration (FHWA)

Name: Location: Date:

I hereby grant to the FHWA the absolute and irrevocable right and permission, in respect of the photographs or audio or video recording and their transcripts, that it has taken or has had taken of me or my child, _________________________, or in which I or my child may be included with others, to copyright the same, in its own name or otherwise (and assign my rights throughout the world in such photograph and audio and video recordings and their transcripts), to use, reuse, publish, and republish, and otherwise reproduce, modify and display the same, in whole or in part, individually or with other photographs, and with any copyrighted matter, in any and all media now or hereafter known, for illustration, promotion, art, advertising and trade, or any other purpose whatsoever; and to use my name in connection therewith if it so chooses.

I hereby release on behalf of myself and my child and discharge FHWA from any and all claims and demands arising out of, or in connection to, the use of the photographs of my child and me, including without limitation any and all claims for libel or invasion of privacy. FHWA may sell, assign license, or otherwise transfer all rights granted to it hereunder.

This authorization and release shall also inure to the benefit of the specific legal representatives, licensees, and assigns of the FHWA, as well as the staff representative(s) (if any) for whom it took the photographs.

I am of full age and have the right to contract in my own name and in the name of my child. I have read the foregoing and fully understand the contents thereof. This release shall be binding upon me, my child, and my heirs, legal representatives, and assigns. I further release the FHWA from any responsibility for injury incurred during the photography or audio or videotaping session.

Signed:
                       (If minor, parent or legal guardian must sign.)

Signer’s Name

Child’s Name and Age:

Address:

City, State, Zip

Phone:

Fax Number:

Date: