J:Data/Compliance/Ad_Index/Releases/Submittal Release_8.15.05.doc
CONSENT AND RELEASE
Instructions:
Adults Each adult must sign a release.
Children: A parent or legal guardian must sign for each mi nor (i.e., subject is under 18 years of age).
Duplicates: Make copies of this form if needed; however, each signature must be an actual ink signature. No
photocopied signatures will be accepted.
I hereby irrevocably consent without further consideration that any photograph, image, artwork, statement,
testimonial, facsimile signature, biography, story or any other material of any kind (collectively, the “Materials”) submitted by
me to “Disney” (defined below), as well as my name, endorsement, voice and likeness, may be used and reused in whole or in
part by Disney at any time or from time to time in perpetuity and throughout the universe, in any form or medium now existing
or hereafter developed (including, among others, motion pictures, newspapers, magazines, radio, free and paid television and
media systems, cable and Internet, worldwide), for any purpose, commercial or otherwise, including, but not limited to,
advertising, promotion, display, merchandising, licensing, broadcast or publication regarding any goods or services offered by
Disney at any time, including, among others, Disney Vacation Club, WALT DISNEY WORLD® Resort and DISNEY
CRUISE LINE®. Disney shall mean any and all affiliates of The Walt Disney Company or Disney Enterprises, Inc. as they
exist from time to time, including Disney Vacation Development, Inc., Disney Vacation Club Management Corp. and Walt
Disney World Co. I hereby further agree that Disneys permission to use any of the foregoing shall include the right without
my prior consent to edit, alter or otherwise modify any of the foregoing as Disney shall see fit. In order to induce Disney to
consider using any of the foregoing, I hereby represent and warrant that I am (i) age 18 or older and am fully competent and
disposed to grant this consent and have the sole right to do so, and (ii) the sole owner and holder of the foregoing, along with
any and all copyrights, trademarks or other rights or properties related to the foregoing, and I hereby release, indemnify and
forever hold harmless Disney from any use by Disney of the foregoing as aforesaid or from any inaccuracy or breach of the
foregoing representations and warranties.
(Print Name) (Signature)
(Street Address)
(City, State/Country, Zip) (Today’s Date)
CONSENT ON BEHALF OF MINORS
(to be used when subject is UNDER 18 years of age)
I hereby affirm and certify that I am the Parent/Guardian of the person named below and that I have read and
understand the foregoing Consent and Release. On behalf of myself and my child or ward named below, I hereby irrevocably
consent without further consideration that any of the Materials described above with respect to such child or ward, as well as
the name, endorsement, voice and likeness of such child or ward, may be used by Disney in the manner described above. I
hereby re-confirm, for myself and on behalf of my child or ward named below, each of the consents, permissions, rights,
representations and warranties, releases and indemnities set forth above. I hereby further covenant and agree that if the child or
ward named below (or his/her successors or representatives) brings any claim whatsoever in contravention of this agreement, I shall
be absolutely and unconditionally liable for all fees, costs and expenses (including attorneys fees and expenses through all appeals)
in connection with such claim .
(Print Childs Name) (Parent/Guardian Signature)
(Street Address)
(City, State/Country, Zip) (Today’s Date)