GCFB - Photograph and Publicity Release Agreement Subject/Model Name(Required) First Date(Required) MM slash DD slash YYYY The undersigned hereby grants to Gleaners Community Food Bank of Southeastern Michigan, and any of its affiliated or related entities (“Gleaners”), the right and permission to use the name of the Model, publish stories, artwork or creative writing or information about the Model. Gleaners may make, copyright, exhibit and publish photographic pictures and/or video tapes in which the Model may appear or may be included for use by Gleaners and/or for the dissemination to the public through any newsletters, pamphlets, booklets, papers, articles or on the internet. The model also agrees that in the event of a public performance or interview, the Model will be asked to express his/her own opinions and views and is not required to express gratitude for services received from Gleaners. The undersigned hereby waives any copyright, publicity rights and rights to any fees, compensation, royalties or profits from the use of the foregoing by Gleaners. The undersigned also acknowledges consent of the above terms Subject/Model Signature (if 18 years or Older)(Required) First Date(Required) MM slash DD slash YYYY Parent / Legal Guardian Signature (if under 18 years of age)(Required) First Date(Required) MM slash DD slash YYYY CAPTCHA