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Publishing Release Form

My child has participated with the Arts and Spirituality Center by submitting poetry or artwork to its poetry journal and web site. I grant the Arts and Spirituality Center, its successors, assigns or agents the perpetual right to use a copy of my child's artwork, writing, or other materials in connection with Arts and Spirituality Center for any lawful, including commercial or promotional purpose. I understand that Arts and Spirituality Center may use my child's artwork, writing, or other material in a book, article, brochure, web site or other media. I hereby release Arts and Spirituality Center, any publisher of its work, and each of its successors, assigns and agents, from any and all claims and causes of action of any kind or nature whatsoever based upon the use of my child's artwork, writing or other material.

 

Print Name of Child: _____________________________________

Print Parent or Legal Guardian Name and Address Here:

_____________________________________

_____________________________________

_____________________________________

 

Please Sign Here: _____________________________

Date: ________________________

Please Send Signed Release to this Address:

We the Poets
Arts and Spirituality Center
3723 Chestnut St
Philadelphia, PA 19104

Phone: 215-386-7705
Fax: 215-222-1015

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