D'VAXVAs Portable Parties, LLC

Photo & Video Release and Consent (Adults and Minors)

Please complete Part A if you are an adult attendee. A parent or legal guardian must complete Part B for each participating minor. Media permissions are optional. Leaving a permission unchecked or uninitialed means permission is not granted.

Part A: Adult Photo & Video Release

1. What may be recorded

At the event, workshop, or delivery identified below, D'VAXVAs Portable Parties® and its photographers, videographers, or contractors may take photographs, video, audio, and other recordings that include me, my image, voice, or statements.

2. Permission choices

I give permission for the company to use recordings of me only for the uses I initial below. I understand that permission is voluntary and that I do not have to grant it to attend or participate.

• ☐ Initials: ________________Use in the company’s website, social media, marketing materials, and print materials.
• ☐ Initials: ________________Use in paid advertising.
• ☐ Initials: ________________Credit me by my full name.
• ☐ Initials: ________________Identify me by my first name only.
• ☐ Initials: ________________Do not identify me by name.
• ☐ Initials: ________________The name of my company or organization may be mentioned.

For the name options above, please initial one choice. If none is initialed, the company will not identify me by name. I understand the company may crop, edit, or adapt recordings for an authorized use, provided the use does not materially misrepresent me.

3. Uses requiring separate consent

Without my separate written consent, the company will not use my image or recording in a way that suggests I endorse an unrelated product or service, or sell my image or recording to a third party.

4. Compensation and use of recordings

I will not receive payment, royalties, or other compensation for authorized recording or use. The company is not required to take or use any recording, even when I have given permission.

5. Optional testimonial or quotation consent

☐ Initials: ________________I give permission for the company to use my testimonial or the following statement for the uses I selected above:

[Testimonial or statement]

The company may edit an authorized testimonial for length or clarity, but not to change its meaning. No testimonial permission is granted unless this box is initialed.

6. Withdrawing permission

I may withdraw permission by emailing hello@dvaxvasportableparties.com. Withdrawal applies prospectively. The company will stop new uses after receiving my request and make reasonable efforts to remove the recording from digital channels it controls within 30 days. Withdrawal does not require the company to recall or remove materials already printed, distributed, or outside its control.

7. Privacy and contact

The company will store signed forms and recordings with reasonable safeguards and limit access to people who need them for business purposes or authorized use. Recordings may be shared with service providers, such as photographers or hosting platforms, as needed for the uses I authorize. Contact information will be used to administer this release and event-related communications, and will not be sold.

For privacy questions or to withdraw permission, contact hello@dvaxvasportableparties.com. The company’s privacy information is available in our Privacy Policy. Content shared publicly online may be copied or redistributed by others, which the company cannot control.

8. Release

To the extent permitted by law, I release and hold harmless D'VAXVAs Portable Parties® and D'VAXVAs Portable Parties, LLC, and their personnel and contractors from claims arising from the authorized taking or use of recordings under this release, including claims relating to privacy, publicity, or use of my image. This release does not apply to uses beyond the permissions I granted. Rights or claims that cannot be waived under Wisconsin law are not waived.

9. Adult acknowledgment and signature

By signing, I confirm that I am an adult, have read this form, and understand the permissions I have chosen.

Part B: Parent or Guardian Consent for a Minor

Complete one form for each minor. Media permission is optional and is separate from permission to participate in the activity.

1. Parent or guardian and minor

I represent that I am the legal parent or guardian of the minor identified below and have authority to provide the permissions in this form.

2. Permission choices for the minor

Unless I select the no-photo option below, I give permission for D'VAXVAs Portable Parties® and its photographers, videographers, or contractors to photograph, film, or otherwise record the minor at the event or activity listed below, only for the uses I initial.

• ☐ Initials: ________________Use in the company’s website, social media, marketing materials, and print materials.
• ☐ Initials: ________________Use in paid advertising.
• ☐ Initials: ________________Identify the minor by first name only.
• ☐ Initials: ________________Do not identify the minor by name.
• ☐ Initials: ________________The name of the company or organization hosting or associated with the event may be mentioned.
• ☐ Initials: ________________No photos or video of my child. Do not photograph or record the minor.

For the name options above, please initial one choice. The company will not publish the minor’s full name, school name, age, location, or other identifying details alongside an image or recording. If I select the no-photo option, I will identify the minor to staff at check-in so they can make reasonable efforts to honor my choice. I understand that staff cannot guarantee exclusion from every incidental background or group recording, but the company will not knowingly use a recording that identifies the minor after I have selected this option.

3. Uses requiring separate consent

Without my separate written consent, the company will not use the minor’s image or recording in a way that suggests the minor endorses an unrelated product or service, or sell the minor’s image or recording to a third party.

4. Activity and supervision consent

I give permission for the minor to participate in the activity described above. I understand that the company will provide facilitator guidance appropriate to the activity, but the activity is not a substitute for parent, guardian, school, or group supervision. Unless a different arrangement is agreed to in writing, the parent, guardian, or responsible group adult remains responsible for the minor’s supervision, including before and after the activity. I will tell the company about relevant allergies, medical needs, or accessibility needs below.

Permission to participate does not waive claims for injury or other rights that cannot be waived under Wisconsin law.

Allergies, medical, or accessibility information the company should know:

5. Withdrawing permission

I may withdraw media permission by emailing hello@dvaxvasportableparties.com. Withdrawal applies prospectively. The company will stop new uses after receiving my request and make reasonable efforts to remove the recording from digital channels it controls within 30 days. Withdrawal does not require the company to recall or remove materials already printed, distributed, or outside its control.

6. Parent or guardian acknowledgment and signature

By signing, I confirm that I am the minor’s legal parent or guardian, have read this form, and understand the permissions I have chosen. My signature authorizes only the selections I have initialed.

How to use this form

Collect the applicable part at booking or check-in. Keep signed copies securely for at least as long as the related recordings remain in use, and limit access to people who need them for business purposes.

This template is for informational purposes and should be reviewed by a Wisconsin-licensed attorney before use. Nothing in this document creates an attorney-client relationship.