CINEMATIQUE PARTICIPATION AGREEMENT AND RELEASE

By accepting this agreement, I am confirming that I would like to participate in this event. I know that my participation could include physical activity and contact with people I do not know. Other possible risks include bodily injury or damage to property. By signing this form, I take full and complete responsibility for my actions as a participant and release and hold harmless Essex Community Outreach Corporation and all Cinematique Sponsors, Partners, Resource Providers and Participants and their employees, consultants, representatives, and agents (“Cinematique Providers”) from liability or claims related to, or as a result of taking part in this event

RELEASE AND AUTHORIZATION
PHOTO, MEDIA, LIABILITY AND GENERAL

I, the undersigned, do hereby grant permission to Cinematique Providers to use the image of me and my children and the children in my care during Cinematique (“My Children”). Such use includes the display, distribution, publication, transmission, or otherwise use of photographs, images, and/or video taken of My Children for use in materials that include, but may not be limited to, publications, new releases, online postings, printed materials such as brochures and newsletters, videos, and digital images such as those on Cinematique social media. I give unrestricted permission for my and My Children’s image to be used in print, video, and digital media. I agree that these images may be used by Cinematique Providers for a variety of purposes and that these images may be used without further notifying me. I do understand that the child’s last name will not be used in conjunction with any video or digital images. I agree that I will take full responsibility for supervising My Children. I, on behalf of myself and My Children, agree to indemnify and hold harmless Cinematique Providers and their Board of Directors, staff, employees, consultants, and coaches (collectively, "the Cinematique Providers") for any claims and liabilities arising out of any incident occurring during participation in Cinematique. I, on behalf of myself and My Children, hereby waive and release the Cinematique Providers from any and all liability for injuries, illnesses or lost property incurred by me or My Children while participating in Cinematique. I authorize the Cinematique Providers to add my email address to the Cinematique distribution list.

Essex Community Outreach Corporation
7683 SE 27th St, Suite 411
Mercer Island, WA 98040 | (973) 650-2659