Glance Gwinnett Release Form

Please provide the following information to enable our staff to plan for your participation.

In consideration of my acceptance for participation in the Glance Gwinnett program, I do for myself, my heirs and personal representatives hereby and forever release Glance Gwinnett, its officers, employees, affiliates, successors and agents from any and all manner of actions, causes of action, debts, claims, demands or liability for any harm or injury I may sustain arising out of or in any way connected with my participation in the Glance Gwinnett program. I make this release freely, and I acknowledge and assume all risks which may arise out of or may be connected with my participation in the Glance Gwinnett program.

The Glance Gwinnett program values your privacy and requires a signed release form from any participant who is visibly recognizable in a photograph or video. Crowd scenes where no single person is the dominant feature are exempt from this requirement.

These guidelines apply to photographs/videos intended for use in any Glance Gwinnett publication for marketing or public relations purposes, including newsletters, brochures, promotional items, or other materials. A release is also required for photographs/videos used on our website. These rules do not apply when photographs/videos are taken of news events.

By signing this release, I grant the Glance Gwinnett program permission to interview me and/or to use my likeness in photographs and/or videos in any and all of its publications and in any other media, whether now known or hereafter existing, controlled by the Glance Gwinnett program, in perpetuity. I understand that I will not make any monetary or other claims against the Glance Gwinnett program for the use of the interview, photographs, and/or videos.

My (typed) signature below indicates my agreement to the general release and photo release. The TYPED SIGNATURE below will serve as my electronic signature. (Please do not insert any other type of digital signature.)

Please submit a headshot photo suitable for print. The photo should be in a common file format (jpg, png, etc.), a minimum of 125 pixels wide, and no more than 50 MB in size. (It does not need to be a professional portrait.) If you do not have a photo at this time, please email a photo to lserrano@leadershipgwinnett.com as soon as possible. This photo will be used for a directory of participants in your Glance Gwinnett session.