Photo Release

For Adults

Date(s):

Photographer/Producer:

Assignment:

Location:

Activity:

For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I hereby consent and agree to the following:

1. I acknowledge that I am eighteen (18) years of age or older. I hereby grant to Girl Scouts of Western Ohio, and others working for Girl Scouts of Western Ohio or on its behalf, an d each of its respective licensees, successors and assigns (each a “releasee”), the irrevocable, royalty-free, perpetual, unlimited right and permission to use, distribute, publish, exhibit, digitize, broadcast, display, modify, create derivative works of, reproduce or otherwise exploit my name, picture, likeness and voice (including any video footage of the same) (collectively, “media”), or to refrain from so doing, anywhere in the world, by any persons or entities deemed appropriate by Girl Scouts of Western Ohio, for any purpose (except defamatory) including, without limitation, any use for educational, advertising, non-commercial or commercial purposes in any manner or media whatsoever (whether known or hereafter devised) including, without limitation, on the internet, in print campaigns, in-store and via television. I agree that I have no interest or ownership in any of the media.

2. I shall have no right of approval, no claim to compensation and no claim (including, without limitation, claims based upon invasion of privacy, defamation or right of publicity) arising out of any use, alteration, blurring, illusionary effect or use in any composite form of my name, picture, likeness and voice. I agree that nothing in this release will create any obligation on Girl Scouts of Western Ohio to make any use of the media or the rights granted in this release. I hereby release and hold harmless releasees from any claim for injury, compensation or negligence resulting or arising from any activities authorized by this release and any use of the media by Girl Scouts of Western Ohio.

Signature:

Name (please print):

Address: City: State: Zip:

Daytime Phone Number: ( ) Additional Phone (optional): ( )

Email Address*: @

(*will not be used for any other purposes or distributed to third parties)

Region: Troop#: Service Unit: Please return the completed and signed release to your regional Girl Scout Center.

05-9001-02/2021

888.350.5090 | gswo.org customercare@gswo.org

Sales and Use Tax Blanket Exemption Certi cate

The purchaser hereby claims exception or exemption on all purchases of tangible personal property and selected services made under this certi cate from:

(Vendor’s name) and certi es that the claim is based upon the purchaser’s proposed use of the items or services, the activity of the purchase, or both, as shown hereon:

Purchaser must state a valid reason for claiming exception or exemption.

Purchaser’s name

Purchaser’s type of business

Street address

City, state, ZIP code

Signature

Date signed

Vendor’s license number, if any

Title

Vendors of motor vehicles, titled watercraft and titled outboard motors may use this certi cate to purchase these items under the “resale” exception. Otherwise, purchaser must comply with either rule 5703-9-10 or 5703-9-25 of the Administrative Code.This certi cate cannot be used by construction contractors to purchase material for incorporation into real property under an exempt construction contract. Construction contractors must comply with rule 5703-9-14 of the Administrative Code.