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2. First Name*
3. Last Name*
5. Home Address*
7. City*
8. State*
9. ZIP Code*
11. Email Address*
12. Phone Number (Cell or Home)*
14. Age*
15. Category*
    -- Select One --La Verne CommunityLa Verne FunLa Verne LandmarksLa Verne NatureLa Verne Sports
17. Date Photo was Taken*
18. Location of Photo*
20. Photo Caption*
21. Digitally Altered Photo

    1. Yes, my photo is digitally altered

    Check this box if your photo has been significantly edited beyond basic adjustments.

23. Release, Indemnity and Warranties Agreement*

     

    In consideration of being permitted to enter the City of La Verne's photography contest, entrant declares and agrees as follows: I declare and affirm that I am the person who took the submitted photograph and the entry was photographed within La Verne city limits; own all intellectual property rights to the photograph and the content therein, and am legally authorized to submit the photograph. Each person(s) who may appear in the photograph has given his/her written consent to be included, and for the photograph to be displayed by the City of La Verne (CITY) on their websites, reproduced in publications or displayed in any form without any fee or other form of compensation, and the photograph entered has not been previously published.

    I agree to indemnify, defend and hold the CITY, its elected officials, officers, and employees free and harmless from any and all claims, damages, costs and liabilities, arising out of any alleged infringement or violation of any intellectual property or other rights, as a result of my submission of any photograph to the CITY, or the CITY duplication and/or use of the photograph for any purpose. This indemnity obligation applies to claims of infringement or violation alleged by me, the photograph subject(s) and/or any and all other persons or entities.

    All entries remain the property of the entrant/photographer. By entering the contest, I agree to grant royalty-free, perpetual, non-exclusive license to publicly display, distribute, reproduce, in whole or in part, in any form for the purpose, including, but not limited to, advertising and promotion of the CITY without any fee or other form of compensation. Any photograph reproduced will include a photographer credit as feasible.

    The CITY assumes no responsibility for lost or damaged entries or those not received by contest deadline. All winning entrants will receive prizes determined by the CITY, and no other prize or consideration of any nature will be provided other than those listed in the official rules.

    By checking the box below, I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

    1. I agree.
27. Signature of Parent or Guardian of Youth Entrant

    If the photograph was taken by a minor under the age of 18, I affirm and declare as set forth above that I am the minor’s parent or legal guardian and that I expressly consent to the photograph being entered in the CITY’s contest and may be displayed on the CITY’s website and used in any CITY publications if it is selected for such use.

    By checking box below, I agree to the above agreement.

    1. I agree.
29. Upload Entry

    Click "browse" link to search for file to upload.

30. Questions

    For more information, please call City Hall at (909) 596-8726. 

Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

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