Media Release Form


I,client, for consideration which I acknowledge, consent to the use of my likeness and grant to Burnout to All Out (“Company”) and Company's assigns, licensees and successors the right to copy, reproduce, and use all or a portion of the statements (the “Work”) for incorporation in Burnout To All Out.

I grant the use of all or a portion of the Work and any of its derivatives in all forms and media electronic, print and other, including advertising and related promotion throughout the world and in perpetuity without compensation. I grant the right to use my name or pseudonym in connection with all uses of the Work and waive the right to review or approve use of the Work.

I release Burnout To All Out and Healthy Henault Horizons assigns, licensees and successors from any claims that may arise regarding the use of the Work including any claims of defamation, invasion of privacy, or infringement of moral rights, rights of publicity or copyright. I acknowledge that I have no ownership rights in the Work. Burnout To All Out is not obligated to utilize the rights granted in this Agreement.

I have read and understood this agreement and I am over the age of 18. This Agreement expresses the complete understanding of the parties