MEDIA RELEASE | Legendary Smiles

WEBSITE AND MEDIA RELEASE

Guardian First Name

Guardian Last Name

Child's First and Last Name

Guardian Email

**By checking the below checkboxes I am giving consent to the following statements** --------------------------------------------------------------------------------------------------------------------- I, the legal guardian, do hereby grant permission to Legendary Smiles and its subsidiaries to post my and/or my child’s story, photo, or other item, hereinafter referred to as “Materials,” I submit to and for Legendary Smile’s website, Instagram, Facebook, and other Social Media accounts. I hereby release you, your representative, employees, managers, members, officers, parent companies, subsidiaries, and directors, from all claims and demands arising out of or in connection with any use of said “Materials”, including, without limitation, all claims for invasion of privacy, infringement of my right of publicity, defamation and any other personal and/or property rights.

I acknowledge and agree that no sums whatsoever will be due to me as a result of the use and/or exploitation of the “Materials” or any rights therein.

Date

Electronically sign by entering your Initials

I acknowledge the above information is truthful and accurate.

Yes

Thanks for submitting!