I, the undersigned, warrant that I am over the age of eighteen years old, and I am signing this on behalf of myself or that I am the parent or legal guardian of the below named minor child and have full right and authority to enter into this release on behalf of myself and or the minor child.

In consideration as an attendee of the Safe Driving Summit of the minor’ named below, and for other good and valuable consideration the receipt of which is hereby acknowledged, I, the undersigned, hereby grant the Lutzie 43 Foundation and Georgia Department of Transportation, their officers, employees, successors, licensees and assigns, the right to take, use, reuse, and publish photographs (picture, film or digital photograph, motion picture film, videotape, or similar visual representations or images), including but not limited to name, voice and image (either alone or with others) which can be used as part of any content to be created for the purposes of advertisement, fundraising, publicity, or promotion, in any and all forms, including but not limited to, news releases, websites, social media, photographs, video, marketing and exhibition for a period of no more than six months after the event.

I understand and acknowledge that these images and recordings may be used for a variety of purposes, as outlined above, without further notification and that I shall have no right of approval of the finished product(s), the advertising copy, or printed matter that may be used, no claim of compensation and no claim arising out of any use or alteration of to which it may be applied. I hereby release, discharge and agree to hold harmless the Lutzie 43 Foundation and the Georgia Department of Transportation and its officers, employees, legal representatives, agents, and assigns, from any injury, compensation, negligence or liability by virtue of use of the images, in any form, that may occur or be produced in the taking of said picture or in any subsequent processing thereof, as well as any publication, broadcast or transmission thereof, including without limitation any claims for libel or invasion of privacy.

By completing this form, I, the undersigned, agree that I have read this Photo Release, Consent Form & Publicity Waiver, fully understand its contents, and I consent to the terms and conditions herein. This release shall be binding upon the minor and me, and our heirs, legal representatives and assigns.

Students under the age of 18 cannot consent and this form must completed by a parent or legal guardian.