NIL Disclosure

IMG Academy Requires Student-Athlete Disclosure of all Name, Image, Likeness Agreements

I am an:

I am an: IMG Academy student-athlete Parent/guardian of an IMG Academy student-athlete Agent of an IMG Academy student-athlete
If Parent/guardian or agent of student athlete, please provide contact information:
Name Name First Last
Email
Phone Phone - ### - ### ####
Student-Athlete Name Student-Athlete Name First Last
Student-Athlete Sport
Student-Athlete Graduation Year
Student-Athlete Email Address
Name of Business Contracting with Student-Athlete
Point of Contact at the Business Point of Contact at the Business First Last
Point of Contact Email
Point of Contact Phone Number Point of Contact Phone Number - ### - ### ####
Type of Endorsement
If selected other, please describe the arrangement:
Did you use an online NIL Marketplace?

Did you use an online NIL Marketplace? Yes No
If yes, please provide the name of the marketplace
Total agreed upon value of the opportunity:

What is the total combined value of payment and/or product the business is paying you for your endorsement?

USD Amount (cash + product value):
Do you have a formal contract for this arrangement?

Do you have a formal contract for this arrangement? Yes No
If yes, please upload a copy of the arrangement.

Attach Files
How long is this agreement?

Note: FHSAA bylaws mandate all NIL deals must conclude once the student-athlete graduates from high school.
Does this agreement require the student-athlete to endorse a product or service while using IMG Academy marks and logos?

Does this agreement require the student-athlete to endorse a product or service while using IMG Academy marks and logos? Yes (please email [email protected] for pre-approval) No
How was this agreement arranged?

How was this agreement arranged? Agent Company contacted student-athlete directly (social media, email, phone, etc.) Company contacted student-athlete in-person Company contacted a member of the student-athlete's family Other
Please read and confirm the following statements required by IMG Academy Policies:

I have read and attest to the following:

1. To the best of my knowledge, IMG Academy nor any entity whose purpose includes supporting or benefiting IMG Academy arranged/facilitated the agreement disclosed herein nor provided payment or any other form of compensation for this agreement.

2. I have provided complete and accurate information regarding this activity involving the use of my Name, Image and Likeness or, if submitting on behalf of a student-athlete, the referenced student-athlete's Name, Image, and Likeness.

3. I acknowledge and understand that the NIL-related information contained in this disclosure is provided for notification purposes only to assist IMG Academy in promoting compliance with applicable FHSAA rules and policies. It is the responsibility of the student-athlete and their family to comply with applicable laws, rules and policies, and receipt of the information by IMG Academy does not indicate approval. IMG Academy cannot provide legal, financial, or other professional advice (including contractual advice and analysis) to student-athletes, and this disclosure does not establish an agent-client, attorney-client, or any other fiduciary relationship. While IMG Academy is available to provide information and answer questions about rules and policies, IMG Academy encourages student-athletes to seek independent professional counsel before entering into any NIL arrangement.

4. I have reviewed and understand the FHSAA bylaw 9.9.4 (Name, Image, and Likeness (NIL)) as well as the IMG Academy NIL policy and to the best of my knowledge, this agreement complies with all applicable bylaw and policy guidelines.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

NIL Disclosure

NIL Disclosure

If Parent/guardian or agent of student athlete, please provide contact information: