AUTHORIZATION FOR USE OF IMAGE OR LIKENESS

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I, hereby authorize Birthday Bash Box, a Texas non-profit corporation (the “Corporation,”) and its directors, officers, members, employees, agents, representatives, contractors, and personnel who are acting on behalf of the Corporation to create and/or obtain and use my name, photograph, video or audio recording, artwork, voice or excerpts of my written or verbally expressed words, or other likeness of myself  or the child I am applying for a Birthday Box for. (collectively, “My/Our Likeness”) taken in connection with the Corporation’s services, programs, or activities.

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I relinquish and give the Corporation all rights, title, and interests in and to My/Our Likeness, including any copyright therein, and I agree that the Corporation may use My/Our Likeness for purposes, including, but not limited to, advertising, publicity, marketing, promotion of the Corporation and its various programs, video presentations, illustrations, reproductions, publications, news releases, mail-outs, e-mails, brochures, placement on websites, social media, and/or other electronic delivery, promotion on any and all other media not now known or later developed, including the Internet, or any other lawful purpose (collectively, the “Purposes.”) I further understand that My/Our Likeness may be subject to reasonable modification or editing by the Corporation. I acknowledge that the Corporation has the right to make one or more photographs, videotape or disk presentations, or other electronic reproductions of My/Our Likeness in accordance with this Authorization for Use of Image or Likeness (hereinafter referred to as this “Authorization”). I waive the right to inspect or approve the finished product or material which may be created in connection with the Corporation’s use of My/Our Likeness.

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I understand that, although the Corporation will endeavor to use My/Our Likeness in accordance with standards of good judgment, the Corporation cannot warrant or guarantee that any further dissemination of My/Our Likeness will be subject to the Corporation’s supervision or control. I am aware that a member of the public may, without my or the Corporation’s permission, use or alter my image in a way that would show me in a false light. Accordingly, I release the Corporation from any and all liability related to the dissemination, reproduction, distribution, or display of My/Our Likeness in print or any and all other media, and any alteration, distortion or illusionary effect of My/Our Likeness, whether intentional or otherwise, in connection with said use.

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I acknowledge and agree that no payment or consideration will be due to me for the Corporation’s use of My/Our Likeness. I also understand that I may not withdraw my permission for the use of My/Our Likeness which was granted in this Authorization. This Authorization binds and benefits my heirs, successors, assigns, and legal representatives.

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This Authorization shall be governed by and interpreted in all respects in accordance with the substantive laws of the state of Texas, without regard to its conflicts of law principles. I irrevocably agree that any matters directly or indirectly arising under or relating to this Authorization, including torts, shall be resolved exclusively in the state or federal courts located in Harris County, Texas. I hereby consent to such venue and to the exclusive jurisdiction of any court in Harris County, Texas over any such dispute.

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If any provision of this Authorization is determined to be illegal or unenforceable by a court of competent jurisdiction, that provision is severed from this Authorization and the other provisions remain in force. This Authorization constitutes the final, exclusive agreement between the Corporation and me on the matters contained in this Authorization. All earlier or contemporaneous oral or written representations, discussions, negotiations, understandings, or agreements relating to this subject matter are merged into and superseded by this Authorization. This Authorization may not be modified or amended except by a written instrument that identifies itself as an amendment or a modification to this Authorization and that is signed by both myself and the Corporation.

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By checking the box and proceeding, I am acknowledging that I have read this Authorization and fully understand and agree to its terms. I understand that this Authorization, when signed by me, will be fully binding on me. I have not been induced or coerced in any way into signing this Authorization. I have the legal right and capacity to execute this Authorization.