973-383-1777

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Villa Capri in the Ames Plaza, Newton, NJ.

Media Release Form

Pizza Pasta Boarder

  
Legal-Ease Version

Villa Capri Pizza of Newton, NJ and any related persons or entities can use my name, quotes, photo, video, audio or their derivatives (referred to as "works") in any form, for any publication, for any reason except for the sole purpose of causing me malicious harm. 

This legal-ease version is provided as a summary of the official legal version below and is itself not legally binding alone.  The official legal version is provided in the store and also posted on our website.

Official Legal Version

I do hereby give to Villa Capri Pizza of Newton, NJ, their related persons, entities, assigns, licensees, successors in interest, legal representatives, and heirs (here forth referred to as "Villa Capri Pizza") the irrevocable right to use my name (or any fictional name), quotes, image, picture, portrait, photograph, video, and/or audio (here forth referred to as "works") in all forms and in all media and in all manners, without any restriction as to changes or alterations (including but not limited to composite or distorted representations or derivative works made in any medium) for advertising, trade, promotion, exhibition, or any other lawful purposes, and I waive any right to inspect or approve the works or finished version(s) incorporating the photograph(s), including written copy that may be created and appear in connection therewith.

I hereby release and agree to hold harmless Villa Capri Pizza from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form whether intentional or otherwise, that may occur or be produced in the taking of the works or in any processing tending toward the completion of the finished product, unless it can be shown that they and the publication thereof were maliciously caused, produced, and published solely for the purpose of subjecting me to conspicuous ridicule, scandal, reproach, scorn, and indignity.

I agree that Villa Capri owns the copyright of the works and I hereby waive any claims I may have based on any usage of the works or derivatives of the works, including but not limited to claims for either invasion of privacy or libel. I am of full age and competent to sign this release or I am legally able to give such consent for the model as noted below. I agree that this release shall be binding on me, my legal representatives, heirs, and assigns

Consent (if applicable)

I am the parent or guardian of the minor named above and have the legal authority to execute the above release. I approve the foregoing and waive any rights in the premises.
 

Media Release Form

   
Provide your model number, name and email below.  Your phone number is optional. The consent information is required for models under 18 years old.  Consent will be verified for minors prior to use of their works (e.g., image).  

Use the "Send Mail!" button at bottom if you agree with the official legal release form.

The model number was given to you at the time of the recording.  If this number if not known then provide a simple description of the recording time/place/event or yourself in the comments below so we can match it to you.

Your works (e.g., photo) may not be used and you will not be notified if they are used.
 
Model Number

  Model's Name

E-Mail
Phone (Optional)
   
Consent (if model is under 18 years old)
    
Parent or Guardian

E-Mail

Phone
   

Comments 

   
  Click to Print for Your Record Before Send Mail!
    
You agree to all of the above by using "Send Mail!" below.
   
 
 

    

Menu and Prices Subject to Change without Notice
Tax Not Included

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Villa Capri Pizza - 1 US Route 206 North - Newton, NJ 07860 - (973) 383-1777
www.villacaprinewton.com

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