GSK Science in the SummerTM Model Release Form

I hereby grant Glaxo Group Limited, GlaxoSmithKline Plc and all subsidiaries of GlaxoSmithKline Plc and its affiliates (together “GSK”)  and Exploration Place Inc. (otherwise referred to as EP), it’s agents, assigns, licensees, successors in  interest and legal representatives the right to use, copy, synchronize, edit distribute, publish, display and exhibit all video, photographs, recordings/sounds, statements and any other media (together “Media”) that GSK or EP records or obtains of, about, or including me or my property, in accordance with this General Release in perpetuity.


The Media may be used for any purpose and without limit in time or form of media on a worldwide basis. I understand and agree that the Media may or may not contain attributions specifically identifying me or any of my property. GSK and EP shall be under no obligation to submit to me the final edit of the Media for my approval prior to distribution or use thereof.


All photographers and videographers taking photos and video on EP property, of EP events or for use by EP must obtain a signed general model release form from any staff or member of the public who is visibly recognizable in the photograph or video.  Crowd scenes where no single person is the dominant feature are exempt.


I hereby hold harmless and release and forever discharge GSK, EP and its entities from all claims, demands and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate or may assert as arising there from. 


GSK and EP may reproduce, display or otherwise disseminate the Media in whole or in part.  I acknowledge that I will receive no compensation from GSK or EP other than any goodwill and publicity that I may receive relating to the publication, distribution or other use of the Media as set forth in this General Release.


I acknowledge that either GSK, EP or its licensees are the sole and exclusive owners of all right, title, and interest in and to the copyright and any and all other intellectual property rights, worldwide, in the Media and the individual components thereof. Any copyright, rights in product and brand names including trade mark rights and/or any other intellectual property rights featured in the Media that belong to GSK or EP shall remain the exclusive property of GSK and EP.

My electronic signature is the legal equivalent of my manual signature and I consent to be legally bound by my electronic signature below. I am 18 years of age or older and am competent to contract in my name. I have read this release before signing below and I fully understand the contents, meaning, and consequences of this release.

If the person signing is under age 18, there must be consent by a parent or guardian, as follows:

I hereby certify that I am the parent or guardian of

and do hereby give my consent without reservation to the foregoing on behalf of this person.

My electronic signature is the legal equivalent of my manual signature and I consent to be legally bound by my electronic signature below.

Parent/Guardian Signature