Cosplay Contest - Contestant-Culpepercon

Cosplay Contest - Contestant

This is your first step towards walking the runway. Please fill out to be part of the cosplay fun.

First Name

Last name

Phone Number

Address

Age of Cosplayer

Character Name

Is it an interpretation of a familiar character, or is it an original creation?

Interpretation of familiar character

Original character created by my imagination

What do you like most about your character?

What made you choose this character?

What are the supplies you used?

How did your costume come together?

Completely hand-made

Store-bought, pre-made costume

An alteration/modification of store-bought costume pieces and home-made

TALENT RELEASE FORM

I hereby grant to Culpeper County Library the irrevocable and unrestricted right to copyright, in its own name or otherwise, and use, re-use, publish and re-publish my image, likeness and sound of my voice, as recorded on video or by any other means, including but not limited to photographic images, audio, video or other electronic recordings, without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published or distributed. Further, I understand and waive the right to inspect or approve the finished product wherein my likeness appears. I hereby release, discharge, and agree to hold harmless Culpeper County Library, its officers, directors, employees, agents, representatives and assigns, and all persons acting under its permission or authority or those for whom it is acting, from any liability arising from the actions or inactions of the videographer, photographer, or any other person whom is making the recordings or any assistants, agents, or representatives of such. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I also understand that this material may be used in diverse settings within an unrestricted geographic area.

Culpeper County Library reserves the right to use this video or any other type of recording, including but not limited to photographic, audio or other electronic recordings, of my likeness and sound of my voice on any portion of its public web site and in other Culpeper County Library publications and presentations, including those hosted by third parties, without compensation.

I acknowledge that I have read and understood the terms of this release, prior to its execution; I fully understand the contents and consequences thereof. This agreement shall be binding upon me and my heirs, legal representatives and assigns.

If under the age of 18 years, parent or legal guardian must also sign this form.

You may be expected to sign this form in-person when entering the building on Friday, March 21, 2025.

Your signature or legal parental guardian's signature, if you are under 18.