Photograph & Publicity Release Form

By signing I give Woerth It Hollow, Inc., its agents, subsidiaries, affiliates, directors, officers, employees, and assignees permission to use my name, likeness, image, voice, and appearance and the name, likeness, image and appearance of my animals when they are on the premises of 269 Cooper Drive, Kirkwood, PA 17536 as such may be embodied in any pictures, photos, video recordings, audiotapes, digital images, and the like, taken or made on behalf of Woerth It Hollow Inc. I agree that Woerth It Hollow, Inc., and its agents, subsidiaries, affiliates, directors, officers, employees, and assignees have complete ownership of such pictures, etc., including the entire copyright, and may use them for any purpose consistent with the mission of Woerth It Hollow Inc. These uses include, but are not limited to illustrations, bulletins, exhibitions, videotapes, reprints, reproductions, publications, advertisements, and any promotional or educational materials in any medium now known or later developed, including the Internet. I acknowledge that I will not receive ANY COMPENSATION, for the use of such pictures, and hereby release Woerth It Hollow Inc. and its agents, subsidiaries, affiliates, directors, officers, employees, and assignees from any and all claims which arise out of or are in any way connected with such use. I acknowledge that this document is a contract and I agree that if a lawsuit is filed against Woerth It Hollow Inc., its agents, subsidiaries, affiliates, directors, officers, employees, or assignees, it is a breach of this contract and I, the undersigned, will pay ALL attorney’s fees and any costs incurred by Woerth It Hollow, Inc. its agents, subsidiaries, affiliates, directors, officers, employees, or assignees in defending such action.

I have read and understood this consent and release.

I give my consent to Woerth It Hollow Inc., its agents, subsidiaries, affiliates, directors, officers, employees, and assignees to use my name, likeness, and any and all property to include my horses to
promote Woerth It Hollow, Inc. or any other activities deemed appropriate by Woerth It Hollow, Inc., its agents, subsidiaries, affiliates, directors, officers, employees, or assignees.