Name *

First Name

Last Name

By checking this box, I grant permission to the Town of North Hempstead and its agents/employees to use photographs, images, and/or video audio taken of me on the Town’s North Hempstead’s Got Talent program and on the Town’s social media/internet sites. Furthermore I authorize the use of my image, likeness, and voice for the promotion of the Town’s program North Hempstead’s Got Talent. I hereby agree to release and hold harmless the Town and its agents or employees including any firm distributing the finished product in whole or in part, whether on paper, via electronic media, or on Web sites, from any claim, damages or liability arising from the use of the photographs/video images. *

I agree