Duck Tape Club - Rock About the Roll

release form

If you are submitting your entry online, we would prefer you submit your release form by taking the following steps:

(1) Click here to download the PDF version of the Release Form.

(2) Read and complete the Release Form.

(3) Scan in the Release Form using the following guidelines:

Trim the 8-1/2 x 5-1/2 form before scanning (do not scan the entire 8-1/2 x 11 page)

Scan at 100%

Scan at 150 dpi

Save in JPEG format

Duck® Brand Rock About the Roll™ Contest Release Form

In consideration of Henkel Consumer Adhesives, Inc. ("HCA") accepting my entry for the Duck® brand duct tape "Rock About the Roll Contest"Ô (the "Contest"), and for other good and valuable consideration, the sufficiency of which is hereby acknowledged, I hereby grant to HCA, the right to use, publish, and reproduce, for all purposes related to the sale and promotion of Duck brand duct tape and relating to the Contest (the "Purposes"), including publicity, promotion, and advertising, in any media, online or offline, my name, city and state of residence, photograph, likeness, and image, including the photograph entry I have submitted.

I waive any right I may have to inspect or approve the finished product or the advertising or other copy that may be used in connection therewith or the use to which it may be applied.

I grant to HCA all right, title, and interest I may have in the finished pictures, negatives, reproductions, and copies of the original print, and further grant it the right to give, sell, transfer, and exhibit the print in copies or facsimiles thereof, for the Purposes, as it deems fit.

I hereby release and discharge HCA, its affiliates, parents, officers, directors and employees, and all persons acting under its permission or authority, from any and all liability for the use, reproduction, and publication by any of them of such photographs, in any and all publications and other advertising media for the Purposes in any manner in which they deem fit.

I hereby represent and warrant that I am the owner of the photograph submitted and/or have the right and authority to give this release. I hereby indemnify and hold harmless HCA, its affiliates, parents, officers, directors and employees from any and all claims which arise by reason of the utilization thereof as herein contemplated.

Furthermore, I represent and warrant that the musical entry (the "Work") I have submitted for the Contest is an original composition and text created by me. In consideration of HCA accepting my entry for the Contest, and for other good and valuable consideration, the sufficiency of which is hereby acknowledged, I hereby assign to HCA, its successors and assigns, all my right, title and interest, including copyright, in the said Work, together with the right to obtain copyright registration of said Work. I agree to sign such additional papers as HCA may request to vest the right, title and interest in the Work in HCA.

Signature: _________________________

Address: ___________________________________

City, State, Zip: _________________________________________________

Name: _____________________________ Age: ___________

Telephone: __________________ Date: _______________________

(For use by parent or guardian of minor child) I represent that I am the parent or guardian of the minor named above and have the legal authority to grant and execute the above consent and release. I hereby approve the foregoing and agree that this grant and release binds me and the minor to all the terms contained herein.

Witness Signature: ________________________________________________

Parent/Guardian Signature: _______________________________________

Witness Name: __________________________ Date: ___________

Parent/Guardian Name: __________________ Date: ____________