Breakthrough Dance Image Release Form

I, hereby authorize Breakthrough Dance and Anakarina Swanson to the following:

(i) Record my likeness and/or voice on a video, audio, photographic, digital, electronic or any other medium;

(ii) Use my name and biographical material in connection with such recordings;

(iii) Use, reproduce, exhibit, and/or distribute my name, biographical material, and such recordings in any medium (e.g. print publications, video, internet, etc.) for promotional, advertising, educational, and/or lawful purposes.

I release and waive and claims or rights of compensation or ownership regarding such uses and understand that all such recordings shall remain the property of Breakthrough Dance.

I certify that I am 18 years of age or older or that my parent/guardian has agreed to this release form.