©2021 Nebraska Farm Bureau | Student Project Grant Application | Page 6
PHOTO RELEASE FORM
I hereby grant Nebraska Farm Bureau permission to use my likeness in a photograph or video in any and all of
its publications, including website entries, without payment or any other consideration.
I understand and agree that these materials will become the property of the Nebraska Farm Bureau and will
not be returned.
I hereby irrevocably authorize the Nebraska Farm Bureau to edit, alter, copy, exhibit, publish, or distribute
this photo/video for purposes of publicizing the Nebraska Farm Bureau’s programs or for any other
lawful purpose. In addition, I waive the right to inspect or approve the nished product, including written
or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other
compensation arising or related to the use of the photograph.
I hereby hold harmless and release and forever discharge the Nebraska Farm Bureau from all claims, demands,
and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting
on my behalf or on behalf of my estate have or may have by reason of this authorization.
I am 21 years of age and am competent to contract in my own name. I have read this release before signing
below and I fully understand the contents, meaning, and impact of this release.
Signature
Parent/Guardian’s Signature
Printed Name
Parent/Guardian’s Printed Name
Date
Date
Date
Date
If the person signing is under age 21, there must be consent by a parent or guardian, as follows:
I hereby certify that I am the parent or guardian of ________________________________________________, named above,
and do hereby give my consent without reservation to the foregoing on behalf of this person.
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