Video Release Form printable pdf download

University of South Alabama Video Release Form

Audio/Film/Video/Photo Release Form

I hereby consent to the use of my name, photograph, image, voice, or other likeness for non-broadcast, publication

purposes including, without limitation, in audio, film, video print or any other electronic means by the University of

South Alabama as it deems appropriate and in its sole discretion.

I further agree that my name and/or photograph or other likeness may be used with visuals, copy or other such

elements for publications, without restriction as to manner, frequency or duration of usage, if any. I further agree

that all such materials produced hereunder may be edited by the University of South Alabama in its sole discretion,

and are and will remain the sole and exclusive property of the University of South Alabama and that I do not have

the right to review such materials prior to their use. I further consent to the use of statements, comments, or

opinions I have made, whether oral or written, referring or relating to the University of South Alabama, its business,

or any University of South Alabama program.

I represent that I am over the age required by law in this state to enter into binding agreements and that I have no

conflicting contractual obligations that would interfere with performing services hereunder or my granting the rights

herein granted. I hereby release and discharge the University of South Alabama from any and all liability arising out

of my participation in or in connection with the University of South Alabama’s project covered by this Release

Agreement. If I am under the age of 19, the signature of my parent/guardian below shall constitute the

parent/guardian’s consent on my behalf to the terms and conditions of this Release Agreement.

This Release Agreement, and the consent given herein, is irrevocable and is given on the express understanding and

condition that no reward or compensation is or shall be due to me or to the undersigned parent/guardian for the

giving of this consent.

Signature:___________________________________________________Date:_____________________

Print Name:___________________________________________________________________________

Address:______________________________________________________________________________

Telephone:____________________________________________________________________________

FOR MINORS UNDER 19 YEARS OF AGE

Signature of Parent/Guardian__________________________________Date:_____________________

Print Name:___________________________________________________________________________

Address:______________________________________________________________________________

Telephone:____________________________________________________________________________

Print Child’s Name:____________________________________________________________________

Print Teacher’s Name:__________________________________________________________________

Video Release Form