Click here to download the waiver. FULL AUTHORIZATION AND RELEASE FOR USE OF QUOTES, STATEMENTS, PHOTOGRAPHS, VOICE, AND IMAGESAuthorization for use: By signing this document I hereby release to embrella and their affiliates, successors and assigns, and those acting under their permission or upon their authority (hereinafter collectively referred to as embrella) all rights to utilize, reproduce, copy, modify, create derivatives or otherwise use the images, likenesses, photographs, recordings, video and audio tape taken of me by embrella and any written or oral statement or communication made by me to embrella, or any artistic image or drawing created by me for embrella, regardless of the format of reproduction or utilization whether now existing or created in the future, for the purpose of inclusion in embrella’s marketing, informational, educational, contractual or fundraising or other materials. Use of words and images: I understand that these quotes, statements, testimonials, photographs, audio and video recordings, images, drawings etc., may be used by embrella in perpetuity in whatever format chosen by embrella to promote its services, operations and/or events. I waive any right I may have to inspect or approve the finished product that may be used or to which any such items may be applied now or in the future. I also waive any right to compensation arising from or related to the use of these items, as well as any claim for damages arising from defamation, invasion of privacy or any other legal claim based upon or related to the use of my words or images. Signature and permission: I warrant and represent that I am over the age of eighteen (18) and that I have read this release in its entirely and fully accept it terms and that I am executing this release voluntarily. Date* MM slash DD slash YYYY Name* First Last Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country By checking here I hereby authorize embrella to use my name and/or the first initial of the minor in association with any of the quotes, statements, photographs, recordings, drawings or the like included in this release if it so chooses* I agree Complete the following if the individual is a minor or a legal ward in the state of New Jersey: I, the undersigned, warrant and represent that I am the parent, foster parent or legal guardian of the minor named above and that I have read the above release agreement and am fully familiar with the contents thereof and I hereby grant my permission and consent to all of the foregoing. Notwithstanding this release and authorization or the checkbox below, embrella operates within the guidelines of DCP&P policy and will not use names, photographs, video or other recordings of children in foster care where their identities or their status as children in foster care would be revealed. Name First Last Date MM slash DD slash YYYY CAPTCHA Δ
