I, (legal name) , being known within the
Society for Creative Anachronism as (name) , do hereby grant
permission to the SCA for the photograph(s) of me taken by
to be used as follows:
GRANT OF USE
The SCA may publish my photo(s) in The Compleat Anachronist for initial publication and unlimited reprints, as
well as publish my photo(s) in digital form (CD or similar media).
PM NEW 8/10
MODEL RELEASE FORM
**If I am executing this Release as a Parent or Guardian, I consent to the use of my child’s image or photograph as set
out above, and I agree that if despite the Release, my child makes a claim against the SCA, I will hold harmless and
indemnify the SCA for any damages it may incur as a result of said claim.
I affirm and agree:
1. that this agreement shall be binding upon me and my heirs, legal representatives and assigns.
2. that I am over the age of majority and at least eighteen years of age and legally able to sign this release on
my own behalf. If I am not, the name and signature of my legal guardian appear below as authorization
for this use.
3. to indemnify and hold harmless the SCA in the event any claim is brought against the SCA by any person
claiming that this Release is not valid and enforceable or that I did not have lawful authority to grant the
above permission and rights to the SCA.
I have read the above Release prior to its execution and fully understand the contents and consequences thereof.
SIGNATURE
DATE E-MAIL ADDRESS
MAILING ADDRESS
**LEGAL GUARDIAN NAME (Please Print)
LEGAL GUARDIAN SIGNATURE DATE
Society for Creative Anachronism, Inc.
Post Office Box 360789
Milpitas, California 95036-0789
USA
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