Request edit access
Meridies Model Release Form
This form may be completed and e-mailed to an SCA publication for immediate use. SCA publications must have your signature on file to use your material. This signature can be digital in the form of an email from you stating that you agree to the terms of this release.

Once this form is completed, you will receive an email with the content of the form. Releases based on this form are not in effect until it has been forwarded as an email (with the body of the email stating "I agree to this form") to ksmo@meridies.org and you have received confirmation of receipt. This will count as a signature for legal purposes.
Sign in to Google to save your progress. Learn more
Email *
My Legal Name is: *
I am known in the Society for Creative Anachronism as *
I grant permission to the SCA for the photograph of me taken by________ to be used as follows(check all that apply in the next section)
OPTION #1 — RELEASE FOR ALL PHOTOGRAPHS
OTHER OPTIONS — GRANTS OF USE *
The SCA may (check all that apply):
Required
Untitled Title
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.
I understand that I have the right to withdraw permission at anytime through written communication to ksmo@meridies.org
Today's date is *
MM
/
DD
/
YYYY
By writing my name in the following text box, I agree to the terms of the waiver above. *
My mailing address is *
My email address is *
**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
Name of Legal Guardian
Required if signing for a Minor
I acknowledge that I will receive an email with the content of this form and will forward it to the Kingdom Social Media Officer. Releases based on this form are not in effect until it has been forwarded as an email to ksmo@meridies.org and you have received confirmation of receipt. This will count as my signature for legal purposes. *
Required
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy