Video Submission Form

Title of Video:

Team Name—for individuals too!
(e.g. The Rockets; Blue Team):

Complete Name of Each Member of the Team Submitting the Video:

Name of Person Representing the Team/Submitting the Video:

Address of Person Representing the Team (this is where all correspondence/prizes will be mailed):

Street:

City:

State/Providence:

Zip/Postal Code:

Phone with Area Code:

E-mail of Person Representing Team (this is where electronic updates will be sent):

APH Video Contest Release Form

For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby consent to the photographing of myself and the recording of my voice and the use of these photographs and/or recordings singularly or in conjunction with other photographs and/or recordings for advertising, publicity, commercial or other business purposes. I understand that the term "photograph" as used herein encompasses both still photographs and motion picture footage.

I further consent to the reproduction and/or authorization by the American Printing House for the Blind (APH) to reproduce and use said photographs and recordings of my voice, for use in all domestic and foreign markets. Further, I understand that others, with or without the consent of the American Printing House for the Blind may use and/or reproduce such photographs and recordings. APH reserves the right to publicize the video producers by releasing any information provided on the entry form.

I hereby release the American Printing House for the Blind, and any of its associated or affiliated companies, their directors, officers, agents, employees and customers, and appointed advertising agencies, their directors, officers, agents and employees from all claims of every kind on account of such use.

I hereby certify that music in the video is properly licensed, is in the public domain, or was made by the entrants, or is used with permission of the copyright holder.

I certify that to the best of my knowledge, the video does not contain any material that violates or infringes the rights of another person or entity, including but not limited to, rights of publicity and privacy.

I represent and warrant that I have permission from all individuals appearing in the video, including the permission of parents or guardians of minors, to use their names and/or likenesses in the video.

This release is irrevocable, and APH may assign the right to use the images or other materials to third parties.

APH reserves the right to disqualify videos for any reason.

Contestants reserve the right to show or distribute their videos.

Name/Signature of Person Representing the Team*:

Date:

*If person representing the team is under 18:
I, , am the parent/legal guardian of the individual named above; I have read this release and approve of its terms.

Name/Signature (please print):

Date: