Authorisation For Image Rights For Minors

I the undersigned.

Surname…………………………………………………………………………………

Name…………………………………………………………………………………….

Date of birth………………………..…………………………………………………

Adress…………………………………………………………………………………..

And, or,

I the undersigned,

Surname…………………………………………………………………………………

Name…………………………………….………………………………………………..

Date of birth………………………..…………………………………………………..

Adress……………………………………………………………………………………

Certify that we are the legal parental authority  of the opal minor:

Surname.………………………………………………………………………………..

Name………………………………………………………………………………………………..

Date of birth.………………………..………………………………………………………

Who appears  in a work ( photos, films, articles,….)

We authorize, ADLC, the affiliates thereof and/or all providers of its choice as well as the partners thereof, to use the images or any other element of the Minor personality within the Work for free.

We accept that the Work may be reproduced, represented, adapted and in a general way exploited, partly or fully, to participate in the Work, by all means and through known and unknown mode of operation, on all sites and/or services edited or hosted by ADLC and/or the affiliates and partners thereof, on the networks thereof, on the accounts and official pages on social media, through all communication network to the public through electronic means on any receiving device, as well as over TV partners official channels and on content-sharing platforms.

We authorize, for free, and under the same conditions, ADLC, the affiliates thereof and/or all providers of its choice to reproduce, represent adapt and, in a general way exploit, the Work in the context of institutional communication and/or auto promotion

The authorization is granted free of charge.

Date………………………………………….

Place………………………………………..