If any people are in your photograph, please fill out the following form.

WAIVER OF LIABILITY & PHOTO RELEASE: I, the undersigned for myself
and/or as the parent/guardian of the Minor named below, hereby grant permission
and license to the Warrenville Historical Society (hereinafter the “WHS”) to
allow the WHS to photograph, video, record, display and identify myself, or the minor
named below, on the Internet, website, newspapers, newsletters, and advertising
materials such as press releases, for promotional purposes without prior notice and
without compensation. I also grant the WHS express permission and license to use
and identify, for promotional purposes, any photographs of myself or the minor
named below that I may provide to the WHS. The photographic image(s) and any
information about it (including this Waiver Form) in possession of the WHS may be
released pursuant to a lawfully made request under the Freedom of Information Act.
To the fullest extent permitted by law, I the undersigned for myself and/or as the
parent/guardian of the Minor named below, hereby release, indemnify and hold
harmless the WHS, its officials, employees, agents, contractors and volunteers from
any claims, causes, and cause of actions, and the resulting damages, judgments or
offsets, including but not limited to, the cost and expenses of litigation and attorneys’
fees, which may in any way accrue as a consequence of the WHS taking and/or
using the image(s) and information related thereto or the Undersigned’s
ownership of and rights in the photographic image and information associated
therewith or the licensing of such to the WHS.
Signature: ____________________________________________
Date: ____________________________________________
Print Name: ____________________________________________
Street Address: ___________________________________________
City: _________________________ State: _______ Zip: __________
Print Name of Minor and relationship to Minor:
________________________________________________________
Warrenville Historical Society Media Waiver 2021
Warrenville Historical Society
3S530 Second Street
PO Box 311
Warrenville, IL 60555
info@warrenvillehistorical.org
(630)393-4215