Media Consent printable pdf download

Media Consent

NASA / KSC EDUCATION OFFICE

Adult Media Release

I, ___________________________________ do hereby give permission

(print name)

to be photographed and/or videotaped by NASA or its representatives. I

understand and agree that the photographs and/or video footage

containing my image and/or voice will be used in the production of

instructional and/or promotional materials associated with the NASA / KSC

Education Office and that such materials may be distributed to the public

and displayed publicly. I also understand that my permission authorizing

NASA to use the photographs and videotapes in such material is for the life

of the specific activity for which the materials are intended and that I will

not receive compensation for granting this permission.

I acknowledge that NASA has no obligation to use my image or voice in

connection with the NASA / KSC Education Office.

I hereby unconditionally release NASA and its representatives from any

and all claims and demands arising out of the activities authorized under

the terms of this agreement.

By signing below, I represent that I am at least 18 years of age, I have read

the foregoing agreement and am familiar with all of the terms and

conditions thereof and I consent to its execution. I agree that I will not

revoke or disaffirm the foregoing agreement at any time.

Signature:_______________________________________________

Date:_________________

Media Consent