SAC HC would like to use players’ names, photographs, visual recordings, images, and likeness solely for use in the advertisement, display and promotion of the soccer program of SAC HC, including the use of the images on the SAC HC website, and the right to reproduce and publish such images solely for those limited purposes, subject to the following terms and conditions:

1. The images may be enhanced or altered, but not to the extent of negatively disparage the player’s likeness.
2. The images will not be used in any manner that would be damaging to the player’s character or reputation.
3. Any images of the player supplied prior to the date of this consent shall be deemed to be supplied on the date of this application.
4. The grants, consents and releases stated herein shall be for 70 years.
5. SAC HC may delegate its rights to other companies or persons, but such companies or persons shall be bound by the terms of this document as if they were SAC HC.
6. This consent may be withdrawn at any time by written submission of the parent/guardian.

_____ I agree and permit such usage______ I do not permit such usage

Name of Player: ____________________ Date of Birth of Player: _________

Address of Player: _________________________________________________

Name/Signature of Parent or Guardian:_________________________________

Date: ______________   Email: _______________________________________

Home Phone:__________________  Cell Phone:___________________