Photo Release Form printable pdf download

Photo Release Form

PHOTO RELEASE FORM

I, the undersigned, do hereby consent and agree that the Arkansas Tech University Upward

Bound Programs have the right to take photographs, videotape, or digital recordings of my

child. Though the names of faculty, staff, and administration can be used, it is our policy that

the full names of students will not. Occasionally, it might be necessary to use the first name

of a student, but no last names, addresses, or telephone numbers will ever be used.

I do hereby release to Arkansas Tech University Upward Bound Programs all rights to exhibit

this work in print and electronic form publicly or privately. I waive any rights, claims, or

interest I may have to control the use of my child’s identity or likeness in whatever media

used.

____ I hereby give permission for ATU Upward Bound Programs

to use photos with first name on printed materials and

other electronic forms of communication.

____ I hereby give permission for ATU Upward Bound Programs

to use photos without first name on printed materials and

other electronic forms of communication.

____ I hereby do not give permission for ATU Upward Bound Programs

to use photos on printed materials and other electronic forms of

communication.

Student’s Name: _________________________________________________

Parent or Guardian Signature: ______________________________________

Date: ______________________

Photo Release Form