Name *
Name
Address
Address
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Phone Number
Emergency Contact Phone *
Emergency Contact Phone
I hereby consent that any videotapes, photographs and/or motion picture film for which he/she posed, and/or audio recordings made of his/her voice may be used by Sharon Lynne Wilson Center for the Arts, its assigns or successors, in whatever way they desire, including television. Furthermore, I hereby consent that such photographs, films, and/or recordings and the plates and/or tapes from which they are made shall be the property of the Sharon Lynne Wilson Center for the Arts, and they shall have the right to sell, duplicate, reproduce and make other uses of such photographs, films, recordings, plates, and tapes as they may desire free and clear of any claim whatsoever on my part.