ENTRY FORM

Montgomery County Planning Department / Town of Kensington

Participant name: _____________________________________________________________________________

Address/City/State: _________________________________________________________ Zip: ______________
Phone: ____________________________________________________ Email: ____________________________
Name of parent or legal guardian (if participant is under 18): _________________________________________
Participant's DOB (if participant is under 18): ______________________________________________________
Image location/closest intersection: _______________________________________________________________
Suggested caption: ____________________________________________________________________________

PHOTO SUBMISSION / PERSONAL CONTEST / WAIVER AND RELEASE / HOLD HARMLESS AGREEMENT
In consideration for receiving permission to participate in M-NCPPC's 2009 Day in the Life of Kensington Photo
Contest, I declare and affirm that:

TERMS AND CONDITIONS

1. I am the individual who took the submitted photograph.

2. I hereby grant to the Montgomery County Planning Department and the Town of Kensington to the fullest extent of my rights and interest therein,
the unrestricted, irrevocable and exclusive right and permission to use and reuse, publish, print, distribute and reproduce for public display the
submitted photograph in whole or in part, composite or retouched in character or form.

3. I have obtained consent from each readily identifiable and/or recognizable person in my photo for the unrestricted, irrevocable and exclusive
right and permission to use and reuse, publish, print, distribute and reproduce for public display the submitted photograph.

4. I understand I will not receive a fee or other form of compensation except for the potential to win a one-time contest award.

5. I hereby release, discharge and agree to hold harmless the M-NCPPC from any and all claims, damages, costs and liabilities that may arise as a
result of entering and participating in this photo contest or from any subsequent publication or disclosure of the submitted photograph.

6. The submitted photograph has not been widely published.

7. I am over the age of 18 and have the right to contract in my own name, or if I am not over the age of 18, my parent or legal guardian is signing
this agreement on my behalf.

8. I hereby acknowledge that this agreement will be construed, interpreted and enforced according to the laws of the State of Maryland, in a court
of competent jurisdiction in Montgomery County, MD.

9. I have read and fully understand the terms and conditions herein and affirm that the foregoing is true and correct.

I understand the terms and conditions herein are contractual and not a mere recital, that this agreement is
legally binding and that I have voluntarily signed or agreed to the terms and conditions online of this
instrument.
Signed: _____________________________________________ Date: ___________________________________

If the photograph was taken by a minor under the age of 18, I affirm that I am the minor's parent of legal
guardian and that I consent to the photo being entered in the 2009 Day in the Life of Kensington Photo Contest
Signed: _____________________________________________ Date: ___________________________________

HOW TO SUBMIT YOUR ENTRY FORM:

1. If you are sending digital images, you must agree to our online terms and conditions before you can submit.
Go to www.kensingtonphotocontest.org
2. If you are mailing photographs, print, sign and send entry form via fax 301.495.1310, or mail attn:
2009 Kensington Photo Contest
8787 Georgia Avenue, Suite 301
Silver Spring, MD 20910

Questions? Contact Valerie.Berton@mncppc-mc.org or 301.495.4602