Athlete/Scholar Information Form

*Elementary,Middle and High School Students

Please make a selection *

Digital Action Shots

Sports Cards

Both

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Athlete's Age and Birthday: *

Parent/Guardian Email Address: *

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Parent / Guardian's Name: *

Parent(s) and Athlete Interview Form for Sports Card

Athlete's Sport *

Athlete's current school name and grade level: *

Parent / Guardian's Cell Phone Number *

Athlete's position on the team: *

Team's Name / Coach's Name: *

(Athlete) Who is your inspiration on the college level ? *

I, the undersigned, do hereby consent to the use by The P.L.A.Y.S. of my image or my child’s information on this form, image, voice or both in (1) a video, photograph, audio tape of sport events; and (2) any video, photograph or audio tape reproduced with in whole or in part from the video, photograph or audio tape of club events; regardless of whether these materials are used for fundraisers, advertising, publicity or any other purpose on behalf of The P.L.A.Y.S. In addition, I waive all claims to compensation or damages based on the use of my image or my child’s image, voice or both by The P.L.A.Y.S. I also waive any rights to inspect or approve the finished photograph, video or audio tape. I agree that all such portraits, pictures, photographs, video and audio recordings and any reproductions thereof, and all plates, negatives, recording tape and digital files shall remain the property of The P.L.A.Y.S., unless otherwise noted. I understand that this consent is perpetual, that I may not revoke it, and that it is binding on my heirs and assigns. I warrant that I am at least 18 years of age and that I am competent in my own name insofar as this consent is concerned. I further attest that I have read this consent form and fully understand its contents. *

Athlete's Name / Jersey Number: *

Athlete's City and State *

Athlete's Height: *