PHOTO/VIDEO/IMAGE/LOGO/AUDIO RELEASE FORM

I hereby grant to Chartwells and/or Compass Group USA, Inc. (“Compass Group”) and its successors and assigns the unlimited right and permission to record and/or film, and to use, reproduce, print, publish, broadcast and rebroadcast, display, edit and make derivative works of, my picture, likeness, voice, company logo, brand imaging, brand or company descriptions, and testimonial statement in any and all media by Chartwells and/or Compass Group or anyone authorized by Compass Group, together with the use of my name and signature, for any purpose whatsoever, without compensation to me. All negatives, positives, prints, etc shall constitute the property of Compass Group, solely and completely, including all copyrights therein.

I hereby release and hold harmless Compass Group and its successors and assigns from any and all claims and damages arising out of their use of my name, testimonial statement, voice, picture, and likeness as agreed to in this document, including without limitation any claims based on the right of publicity or privacy.

Item: Information:

Date:

Name:

Employee Number (if applicable):(Personnel Number/PIN)8 numbers on paycheck stub

Sector/Division or Vendor/Company Name:

Full College/University, Vendor/CompanyAddress:

Full Signature:(For authorization/consent purposes)

Witnessed by (signature):