FORMS

Instrument Liability Form

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RELEASE FOR USE OF NAME AND LIKENESS

Parents first name

Parents last name

Childs first name

Childs last name

Parents Email

I hereby grant Hatteras Island Community Strings ("HICS"), their volunteers, associates, and designated representatives, permission to use the name and likeness of my child(ren), to take photographs and/or to make video recordings and/or audio recordings of my child(ren) and to use such photographs or recordings in any and all publications or other media related to HICS without any payment or other consideration. HICS may, in their sole discretion, edit, copy, print, and use said photographs and/or recordings in their programs, bulletins, newsletters, websites, emails and/or promotional materials for any lawful purpose. I hereby release and forever discharge HICS (including their volunteers, associates, and designated representatives) from any and all claims, demands, or causes of action which I, my heirs, family members, executors, or any other person acting on my behalf might have as a result of this release. I hereby attest that I am authorized to sign this release on behalf of myself and my child(ren) who may appear in said photographs or recordings. I hereby confirm that I have read this release before signing it and I fully understand and agree with all of its provisions.

By entering my name below, I am acknowledging that I agree to the terms of this Release for Use of Name and Likeness form.

Parents first and last name

Please list any specific requests below pertaining to your child:

INSTRUMENT LIABILITY

Parents first name

Parents last name

Childs first name

Childs last name

Parents Email

My child is playing a:

Ukulele

Guitar

Violin

Bass

Make/Model/Serial # of Instrument:

I agree this instrument will be safely stored and kept in good condition at all times while in my custody.

In the event the Instrument is lost, stolen or damaged while in my custody, I will promptly notify HICS of such event and I agree to pay HICS, on demand, for the full cost of an equivalent replacement instrument and/or for any repairs to the damaged Instrument (note: this liability specifically excludes any broken instrument strings, which will be replaced free of charge by HICS).

I agree to return the Instrument to HICS upon completion of performance in which the instrument is needed.

I understand that HICS kindly asks for a $5 monthly donation towards the use of this instrument. I will do my best to donate monthly.

This Agreement constitutes the entire understanding and agreement between the parties hereto and with respect to the matters addressed herein. Any changes or modifications to this Agreement shall be made and agreed to in writing by the parties hereto and appended to this Agreement. The Loanee may not assign any of their rights, duties or obligations as described in this Agreement to any other party without the prior written approval of HICS.

By entering my name below, I agree to the terms of this Instrument Liability Agreement.

Parents first and last name: