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Club of Washington, GA
Chartered in 1920
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Affirmation, Reliability and Photo Release Form
Which Competition Are You Submitting This For?
(Required)
MUSIC
ART
Terms
(Required)
I agree
I hereby affirm that I have been well advised and thoroughly informed of the inherent hazards and policies of the event. I know that participating in the Georgia District Kiwanis Art and Music Showcase is a potentially hazardous activity. I should not participate unless I am medically able. I hereby personally assume all risks associated with my voluntary participation in this event for any harm, injury or damage that may befall me as a result of my participation, whether foreseen or unforeseen, including but not limited to falling or injury on or off stage.
Terms Continued
(Required)
I agree
I understand and agree that neither Kiwanis International nor the Kiwanis Club of Wilkes County located in the city of Washington and state of Georgia USA may be held liable in any way for any occurence in connection with my participation in Georgia District Kiwanis Art & Music Showcase that may result in injury, death, or other damages to me or my family, heirs, or assigns, and in consideration of being allowed to participate in this event, I hereby personally assume all risks in connection with said event for any harm, injury or damage that may befall me, including all risks connected therewith, whether foreseen or unforeseen; and further to save and hold harmless said event and persons from any claim by me, or my family, estate, heirs, or assigns arising out of my participation in this event.
Age Verification
(Required)
I agree
I further state that I am of lawful age and legally competent to sign this affirmation and release, or that I have acquired the written consent of my parents or guardians; that I understand the terms herein are contractual and not a mere recital; and that I have signed this document of my own free will.
Release of Liability
(Required)
I agree
It is my intention by this instrument to exempt and release Kiwanis International, the GA District of Kiwanis and the Kiwanis Club of Washington Georgia from all liability whatsoever for personal injury, property damage or wrongful death arising out of or in the course of my participation in this event.
Photo Rights
(Required)
I agree
For and in consideration of my participation with a Kiwanis sponsored event where photos were taken the 2025 Georgia District Art & Music Showcase, I hereby give Kiwanis, its employees, and those acting with its authorization, the right and permission to copyright, use, and/or publish photographic pictures of me in catalog, magazine, literature, web and direct mail promotion. I hereby waive any right to inspect or approve the finished photograph, advertising copy or printed matter that may be used in conjunction therewith or to the eventual use that might be applied.
Photo Release
(Required)
I agree
I hereby release, discharge and agree to hold harmless Kiwanis, its employees or vendors (including any firm publishing and/or distributing the finished product) from and against any liability as a result of any distortion, blurring or alteration that may occur in the taking, processing or reproduction of the finished product, even should the same subject me to ridicule, scandal or indignity.
Agreement
(Required)
I agree
I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS AFFIRMATION AND RELEASE BY READING IT BEFORE I SIGNED IT. I hereby warrant that I am competent to contract in my own name in so far as the above in concerned. I have read the foregoing release, authorization, and agreement before affixing my signature below, and warrant that I fully understand the contents thereof.
Contestant Name
(Required)
First
Last
Contestant Address
(Required)
Street Address
City
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District of Columbia
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Vermont
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Washington
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Wisconsin
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Armed Forces Americas
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State
ZIP Code
Phone (Parent or Guardian Phone if Contestant Under 18)
(Required)
Email (Parent or Guardian Email if Contestant Under 18)
(Required)
Signature (Parent or Guardian Signature if Contestant Under 18)
(Required)
Date
(Required)
MM slash DD slash YYYY
Club Chairman (internal use only)
Date (internal use only)
MM slash DD slash YYYY
Δ
Text
Affirmation, Reliability and Photo Release Form