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2021 LIGHT POLE BANNERS CALL TO ARTIST SUBMISSION CONSENT, WAIVER AND RELEASE FORMThis consent, waiver and release form must be submitted with each separate design. A separate form must also be submitted for each person who contributes to the design(s). By submitting a design to the City of Mount Dora, you are agreeing to abide by the Rules and Regulations of the 2021 Light Pole Banners Call to Artists and that winning entries will be selected by a panel of judges, whose decision is final.
(for myself or my minor child) hereby submit the banner design(s) identified as:
(Design)(s) to the City of Mount Dora (City) for consideration in the 2021 Light Pole Banners Call to Artists. I hereby swear, affirm or certify that I am (or my minor child is) the sole creator or a joint creator of the Design(s). I agree that if the Design(s) is selected as a winning submission, I, on my own behalf and on behalf of my heirs, representatives, executors, assigns, administrators or any other person acting on my behalf or on behalf of my estate, hereby grant the City permission to use all or part of the Design for display on light pole banners throughout the downtown area in Mount Dora, Florida, or for any other purpose that the City deems appropriate. I hereby irrevocably authorize the City, or an authorized agent thereof, to edit, alter, copy, exhibit, publish and/or distribute the winning Design(s) for any and all lawful purposes. In addition, I waive any right to inspect or approve the finished product wherein the winning Design(s) appears. Additionally, I waive any right to royalties or other compensation arising out of or related to the City’s use of the winning Design(s) beyond the initial cash prize.
, hereby grant the City the right to use my name, photograph, statements, quotes and testimonials or the name, photograph, statements, quotes and testimonials of my minor child,
, in relation to the Design(s), regardless of whether the Design(s) is(are) chosen as the winning Design(s), for any lawful purposes without notification or compensation. I specifically acknowledge and understand that the City maintains the right to reproduce, reprint, distribute, display or exhibit the Design(s), if selected as a winning design(s), for advertising, publicity and promotional purposes on its website, social media, television, radio, newspaper, magazine or other media outlets.
I hereby swear, affirm or certify that the Design(s) is(are) an original work(s) and does(do) not violate copyright laws or infringe upon the intellectual property rights of another. I hereby agree to indemnify and hold the City harmless from any claims of copyright infringement or any other claims of third party related to or in any way associated with the Design(s).
I understand that the original Design(s) is(are) still my property and I may take any steps necessary to legally protect my ownership interest, after the Call to Artists has concluded, including copyrighting the design(s) or I may otherwise use the original of the Design(s) as I deem appropriate, so long as the same is not used in a manner that would be considered adverse to the image of the City or would in any way interfere with the City’s rights to utilize the design(s) as it deems appropriate. I understand that this means that I may maintain ownership of the Design(s) or sell, grant, gift or otherwise transfer ownership of the Design(s) so long as the new owner agrees to the City’s right to utilize the Design(s) free of interference.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
(If submitter is under the age of 18)
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