I hereby grant CSNK2A1 FOUNDATION permission to use my/my child’s likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including, but not limited to, web-based publications, without payment or other consideration.

I understand and agree that all photos will become the property of CSNK2A1 FOUNDATION and will not be returned.

I hereby irrevocably authorize CSNK2A1 FOUNDATION to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.

I hereby hold harmless, release, and forever discharge CSNK2A1 FOUNDATION from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I have read this release before signing below and I fully understand the contents, meaning and impact of this release.


Child’s Name

Parent/Guardian Name

Signature Parent/Guardian


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