Test Page

Bit Part and Featured Extra Release Form for Voting Video Contest

(Each such actor in the video must fill out their own release form, have it signed by a parent/guardian as appropriate, and have it included in the single Application)

Video Title *

Others on This Team

Your Name: *

First

Last

Your Birth Date (M/D/Yr): *

Your Email: *

Your Phone #: *

Your High School (name):

Your expected graduation date (Year):

I agree that If the above named video is

• Selected for a prize or honored as a finalist, to grant the LWV an on-going permanent license to post it on LWV-controlled platforms, including LWV-controlled social media — and the LWV may describe it as “prize-winning,” “honored,” “selected by the League,” etc.
• Not selected for a prize or honored as a finalist, that I may not represent it as a League video or as an entry in a League contest without advance written permission from our League

Your Signature: *

Date:

If you are under age 18 as of the date of this submission, you need a parent/guardian to sign their agreement to above release. *

I agree that the video submission that includes video/audio of my child may be submitted under the terms defined above, granting the League of Women Voters of Port Washington-Manhasset an on-going permanent license to post it on LWV-controlled platforms, including LWV-controlled social media.

Parent/Guardian Signature: *

Date:

Parent/Guardian Signature: *

Date:

GDPR