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County of Hawai'i, Office of the Mayor <br />East Hawai'i: 25 Aupuni Street, Hilo, HI 96720 <br />(808) 961-8211 1 Fax: (808) 961-6553 1 TDD: (808) 961-8521 <br />West Hawai'i: 74-5044 Ane Keohokalole Highway, Bldg C, Kailua-Kona, HI 96740 <br />(808) 323-4444 1 Fax: (808) 323-4440 1 TDD: (808) 327-6003 <br />Photograph Release <br />I grant permission to the County of Hawai'i, its agents or employees acting on its behalf, to <br />photograph or videotape me participating in County Programs and do hereby authorize them to <br />use, reproduce, disseminate or publish such photograph(s) in print and/or electronic <br />publications such as brochures, newsletters, social media, websites and magazines, and to offer <br />them for use or distribution to other non -County publications, without notifying me. <br />I understand that I will not be allowed to inspect or approve the finished photograph(s), or <br />printed or electronic matter, that may be used, now or in the future, and I waive any right to <br />compensation arising from or related to the use of the photograph(s). <br />I agree to release, defend, and hold harmless the County of Hawaii, its agents or employees, <br />from and against any claims, damages or liability arising from or related to the use of the <br />photograph(s), including but not limited to any misuse, distortion, blurring, alteration, optical <br />illusion or use in composite form, either intentionally or otherwise, that may occur or be <br />produced in taking, processing, reduction or production of the finished product, its publication <br />or distribution. <br />Please Check One <br />OYES, permission granted O NO, permission denied <br />(If no box is checked, assumption is "No, permission denied") <br />Signature <br />Print name <br />Date <br />Address City Zip code <br />Signature of parent or guardian (if under age 18) Date <br />Print name of parent or guardian <br />