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2. The City of Malibu Poetry and Art License Release Form
4. Section 1

   I am the sole, exclusive, and original author of the poem I have submitted (“Work”). I have not copied in whole or in part any work of another in my Work. For valuable (but non-monetary) consideration, the receipt and adequacy of which are hereby acknowledged, I hereby agree to the following:

6. Section 2

   I grant the City a non-exclusive, worldwide, perpetual, and royalty-free license: to reproduce, publish, use, broadcast, publicly display (including, but not limited to, an anthology of poems and art work or carving into a stone and placed in a City park) modify the formatting of, excerpt, abridge from, distribute, and sell the Work in its entirety or in any portion, individually or in a collective work or other compilation in any form, including but not limited to, the exercise of such rights through internet or intranet sites, computer on-line services, and all other media and distribution mechanisms now known or later developed, for use solely in conjunction with any City purpose, whether or not compensation is received, provided that any excerpts, abridgments, formatting or modifications, do not substantively change the meaning or content of my Work.

8. Section 3
   I grant the City the right to use my name, voice, photograph, biographical information, and likeness in connection with the exercise of rights granted in Section 2 provided that any such uses are made in connection with the City’s purposes.
10. Section 4
    I grant the City the right to license to third parties any of the rights granted in Sections 2 and 3, provided that such licenses are consistent with the terms hereof.
12. Section 5
    Except as provided herein, I am the sole owner of any copyright to the Work, and I retain all rights to reproduce, distribute, perform, or display the Work along with all other rights, privileges, and remedies granted or reserved to a holder of a United States copyright. I, however, grant the City the right to license others to publish the Work as a means of carrying out the mission of the City, except that such licenses granted shall be of a non-exclusive nature.
14. Section 6

    I agree that if the Work is discovered to be copied in whole or in part that I will forfeit the right to have my work published by the City in the future. I agree to indemnify and hold harmless the City, its officers, employees and agents from any claim, legal action or discipline, including any and all costs and attorney’s fees, brought as a result of the Work copying another’s work in whole or in part.

16. Section 7

    The City wishes to publish a Poetry and Art Anthology. Poems and art would also be on the City’s website and Malibu Arts Commission website consisting of photographed art pieces, written work, and other art deemed appropriate by the City (the “Art Work”) from the artist ("Lender").

18. Section 8

    The Lender wishes to participate in the Poetry and Art Anthology by submitting Art Work to the City for the purposes of displaying the Art Work in the Poetry and Art Anthology.

20. Section 9

    If signing this form on behalf of a minor child, I hereby certify that I am the parent or guardian of this minor and do hereby give my consent without reservation to the foregoing on behalf of the minor.

22. I hereby waive any right of notice, inspection, or approval of the uses of the Art Work or the consistent with this license. This license is binding upon me and my successors, licensees, assigns, heirs, executors, and administrators. The rights herein granted to the City may only be assigned to a successor in interest of the City. I agree to be subject to the jurisdiction of courts located in Los Angeles, California, which will be the exclusive forum for any disputes arising under this license.

24. I affirm that I have not accepted or paid, and agree not to accept or to pay, any money, service, or other consideration for my Art Work.

26. Subject to all of the foregoing, I hereby release and discharge the City, including without limitation, its officers, employees, agents, volunteers, and representatives, from any and all claims, demands, and causes of action that I may have against it for use of my Work, including, but not limited to, any claims based on the right of privacy, the right of publicity, copyright, libel, or slander.

28. The Parties agree that this Poetry and Art Release Form will be considered signed when the signature of the party is delivered physically or by facsimile transmission or scanned and delivered via electronic mail or online. Such facsimile or online or electronic mail copies will be treated in all respects as having the same effect as an original signature.

30. BY SIGNING THE BELOW, I HEREBY ACKNOWLEDGE THAT THE WORK IS MY SOLE, EXCLUSIVE, AND ORIGINAL WORK AND I HAVE READ THIS RELEASE FORM AND AGREE TO BE BOUND BY EACH AND EVERY TERM HEREIN.

32. IN WITNESS WHEREOF, the parties have executed this Agreement on the date below.

34. Agreement*

    1. Yes, I Agree

    By checking this box, it certifies that I have read the City of Malibu License and Release Agreement and that I agree to abide by all statements and regulations set forth therein.
36. Legal Guardian Information
38. Legal Guardian First Name*
39. Legal Guardian Last Name:*
41. Legal Guardian Phone Number*
42. Legal Guardian Email Address*
44. Digital Signature*
45. Date *
47. Student Poet Information
49. Minor First Name*
50. Minor Last Name*
52. Title of Poem #1*
53. Title of Poem #2 (if applicable)
55. Title of Artwork (if applicable)
57. School Year*
58. School*
60. Teacher Last Name (do not include first name or prefix)*
61. Grade (number only)*
Leave This Blank:


62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit Submit and Print

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