Lemonade Day

I DO want this address to appear on a public map and/or listing of local lemonade stands to be shared on Synergy’s website and social media. The intent of this is to inform the community of where they can purchase lemonade on Lemonade Day.
I DO NOT want this address to appear on a public map or listed in any location.

OK Please select one: is required

I allow Synergy Bank to use photos of my child and their Lemonade Stand. I grant Synergy Bank permission to use my likeness or my child’s likeness in a photograph, video or other digital media (“photo”) on its digital billboards, web-based publications, or other publications without payment or other consideration. Synergy Bank can use the photo for the purposes of advertising, promotion, and public relations. I irrevocably authorize Synergy Bank to edit, alter, copy, exhibit, publish or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness or child’s likeness appears. I waive any right to royalties or other compensation arising or related to the use of the photo. I hold harmless, release, and forever discharge Synergy Bank from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I acknowledge that I am at least 18 years old, and have the right and ability to consent to the terms herein, and further, that I am authorized and able to sign on behalf of all persons listed as participants.
I DO NOT allow Synergy Bank to use photos of my child and their Lemonade Stand. 2

OK Please select one: is required

OK Safe Stand Location is required

OK Synergy Bank location I would like to pick up my Lemonade Day Kit (Available 4/19-4/30): is required

Security Code

OK Security Code is required

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