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Photo Submission


  1. I hereby certify that I am the photographer of the attached photograph and that I am eighteen (18) years of age or older. I further certify and state as follows:

    • I grant to the City of Moline, Illinois (hereinafter “City”), the non-exclusive right to distribute, use and publish the photograph submitted herewith. Uses may include but are not limited to publication on the City’s internet and in print publications. Said photograph has not been sold or offered to any other person or organization for use or publication.
    • I have not registered, and I waive any and all legal rights, including without limitation, rights protected by state and federal copyright laws, with respect to the photograph attached hereto.
    • I grant to the City, its agents, officers, employees, or assigns, any and all legal rights, including without limitation, rights protected by state and federal copyright laws.
    • For a photograph containing an identifiable person or person’s likeness, I have informed said person of my intent to submit the photograph to the City for its use and publication, and I have obtained the authorization of said person to use his or her image.
    • I release and forever discharge the City, its agents, officers, employees or assigns from and against any and all claims, damages, or injuries whatsoever, arising out of or related to the use of the photograph, including any rights I may have under federal or state law.
    • I indemnify, release and hold harmless the City, its agents, officers, employees and assigns from any and all claims, damages or injuries suffered by any person, myself and my heirs included, which arise out of or are related to the use of the photograph by the City. This release shall be binding upon me, my heirs, executors, administrators and assigns.

  2. By selecting the "I Agree" button, you are signing this photo release electronically. You agree your electronic signature is the legal equivalent of your manual signature on this release. You also agree that no certification authority or other third party verification is necessary to validate your electronic signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your electronic signature.

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  4. This field is not part of the form submission.