Anti-Violence

    I, hereby authorize CITY OF ROCHESTER BUREAU OF COMMUNICATIONS AND SPECIAL EVENTS
    (“The City”) and its officers, agents, and employees, to photograph, film, or video-tape me.

    I understand that any photograph, sound recording, motion picture, or video taken of me under this Anti-Violence Video Campaign is for the purpose of collecting and/or representing factual information in the interest of serving the The City of Rochester’s Office of Violence Prevention, public service, and for promoting the public good.

    I hereby assign to The City all rights, title, and interest, including copyright, in and to any and all such photographs, sound recordings, motion pictures, or videos, and I hereby irrevocably authorize The City, its officers, agents, and employees, without limitation, to reproduce, copy, exhibit, publish, or distribute any and all such photographs, sound recordings, motion pictures, videos, publications, advertisements, billboards, web site images, or other electronic displays and transmissions in perpetuity for the purposes expressed above.

    I further release and forever discharge The City, its officers, agents, and employees from any and all claims and demands arising out of or in connection with the use of said photographs, sound recordings, motion pictures, videos, publications, advertisements, billboards, web site images, or other electronic displays and transmissions including but not limited to any and all claims for invasion of privacy, defamation, or infringement of copyright.

    I have read and understood the provisions of this agreement, and understand that I am free to obtain advice from legal counsel of my choice, at my expense, to interpret these provisions. By signing below, I acknowledge that I have freely and voluntarily entered into this agreement.

    Type your Name Signature:

    If you are under the age of 18 years old you must have a parent or guardian signature.

    Parent/Guardian Signature: