Image Release Form - University Of Waterloo
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1CREATIVE SERVICES
CREATIVE SERVICES
IMAGE RELEASE
IMAGE RELEASE
I, the undersigned, hereby irrevocably consent to and authorize the use by University of
I, the undersigned, hereby irrevocably consent to and authorize the use by University of
Waterloo, its officers and employees, of my image, voice and/or likeness. The University shall
Waterloo, its officers and employees, of my image, voice and/or likeness. The University shall
have the right to photograph, publish, adapt, exhibit, perform, reproduce, edit, distribute,
have the right to photograph, publish, adapt, exhibit, perform, reproduce, edit, distribute,
display or otherwise use my image, voice and/or likeness in connection with any product or
display or otherwise use my image, voice and/or likeness in connection with any product or
service in all markets, media or technology now known or hereafter developed in University’s
service in all markets, media or technology now known or hereafter developed in University’s
products or services, as long as there is no intent to use the image, voice and/or likeness in a
products or services, as long as there is no intent to use the image, voice and/or likeness in a
disparaging manner. I waive any compensation or recourse against the use of these images.
disparaging manner. I waive any compensation or recourse against the use of these images.
SIGN HERE
DATE
SIGN HERE
DATE
PRINT NAME HERE
PRINT NAME HERE
ADDRESS
ADDRESS
PHONE NUMBER
PHONE NUMBER
IF YOU ARE EIGHTEEN – 18 YEARS OF AGE OR YOUNGER,
IF YOU ARE EIGHTEEN – 18 YEARS OF AGE OR YOUNGER,
YOUR PARENT OR GUARDIAN MUST SIGN BELOW:
YOUR PARENT OR GUARDIAN MUST SIGN BELOW:
I represent that I am a parent/guardian of the minor who has signed the above release
I represent that I am a parent/guardian of the minor who has signed the above release
and that in that capacity the University has my consent and authorization to use the
and that in that capacity the University has my consent and authorization to use the
name, voice and/or likeness as described above.
name, voice and/or likeness as described above.
PARENT/GUARDIAN:
PARENT/GUARDIAN:
SIGN HERE
DATE
SIGN HERE
DATE
PRINT NAME HERE
PRINT NAME HERE
ADDRESS
ADDRESS
PHONE NUMBER
PHONE NUMBER
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