I acknowledge that I am the parent/guardian of the child named below and that I have read this consent and release and fully understand, and intend to be legally bound by, its content. I consent to the unrestricted use by the National SCRABBLE® Association ("the NSA"), Hasbro Inc. ("Hasbro") and their affiliates, agents, employees, appointees and assigns of my name, filming, photograph(s), and likenesses of the child named below for editorial, publication or advertising purposes or purposes of trade. I also consent to the attendance and participation of the child named below in the National SCRABBLE® Championship on August 19-24, 2005 and irrevocably release the NSA, Hasbro from any and all claims arising out of or related to the child's participation in the National SCRABBLE® Championship including but not limited to any responsibility or liability for damages, loss or injury resulting from the child's participation in the trip to the competition. I expressly and irrevocably release the NSA, Hasbro, Inc. and their employees, licensees, licensors and assigns from all claims which I or the child named below may have for invasion of privacy, defamation or copyright infringement or any other cause or action arising out of or related to the child's participation in the National SCRABBLE® Championship or to the use or publication of the name, image or likeness of the child named below.
|Signature of ( ) Parent ( ) Guardian||Date|
|Printed Name of Above||Name of Child|
|City, State||Phone # or E-mail|