[INSERT CHAPTER NAME]
Rhosebud Release and Hold Harmless Agreement
1
I, _______________________________ (PRINTED NAME OF PARENT/GUARDIAN), certify that I am
the legal parent/guardian for ________________________________________ and on behalf of myself,
my heirs, assigns and
all other persons or entities claiming by, under or through me, represents covenants
and agrees that I will not hold or seek to hold Sigma Gamma Rho Sorority, Inc., its officers, directors,
regions, chapters, members, affiliates, employees, agents or representatives responsible for any liability
resulting from my child’s participation in activities sponsored by the Rhosebud Club of [INSERT NAME
OF CHAPTER] (“Rhosebud Club”). I further waive and release any and all rights and claims against the
aforementioned parties for any injury or loss suffered while participating in the Rhosebud Club.
For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I
hereby consent and agree to the following:
I hereby grant to the Rhosebud Club, and others working for the Rhosebud Club or on its behalf, and
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 child’s 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 Rhosebud Club, 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, via radio and via television. I
agree that I have no interest or ownership in any of the Media. 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 child’s name, picture, likeness and voice. I agree that nothing in this Release will
create any obligation on the Rhosebud Club 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
the Rhosebud Club.
_____________________________________________________________________________
Parent/Guardian(s) Full Name (PRINTED)
_____________________________________________________________________________
Parent Guardian’s Signature
Date Signed: _____________________
_____________________________________________________________________________
Parent Guardian’s Address (Address, City, State, Zip code):
_____________________________________________________________________________
Parent Guardian’s Email:
_____________________________________________________________________________
Parent Guardian’s Phone Number:
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