I, (parent/legal guardian) hereby authorize, consent and permit Florida Baptist Children’s Homes, Inc., a Florida nonprofit organization, doing business as One More Child, its agents, employees, personnel, licensees, successors and/or assigns (collectively, “OMC”) to record audio of the actions and voice, take video, motion pictures and photographs of and otherwise capture the image and/or voice (“Captured Materials”) and to use the photograph, silhouette, voice and other reproductions of the physical likeness and voice, and the Captured Materials in audiotapes, billboards, brochures, closed circuit television programs, commercials, educational materials, mailings, marketing materials, movies, publication on the Internet or in newspapers, printed media, radio or television productions, signs, videotapes, websites and any other type of audible or visual medium whatsoever whether physical or electronic in nature and whether currently in existence or developed after the execution of this Depiction Use Authorization,

Consent and Release (“Authorization”) of (youth).

I hereby agree not to assert or maintain against OMC any action, claim, demand, or suit of any kind or nature whatsoever, including without limitation actions, claims, demands or suits grounded upon civil rights, invasion of privacy, rights of publicity or for any other reason based upon or arising out of the use of the physical likeness or voice granted hereunder. Accordingly, I hereby release OMC and its assigns, licensees and/or successors from any and all liability related to its use of the Captured Materials.
I hereby acknowledge, agree and consent to this Authorization being governed by the laws of the State of Florida (excluding conflicts of laws rules) and that this Authorization shall not be altered, amended, modified, repealed, revoked or waived, in whole or in part, except by a written instrument executed by OMC and me. If any part of this Authorization is held to be inoperative, invalid or void by a court of competent jurisdiction, the remainder of this Authorization shall continue to be effective.
I understand that permission for this release is not required in order for me to receive the agency’s services.

I hereby acknowledge, represent and warrant that I am eighteen (18) years of age or older, I have read the foregoing contents of this Authorization and fully understand its meaning and effect.