Consent Release Form printable pdf download

Consent Release Form

UT System Office of Communications and Marketing

800 Andy Holt Tower

Knoxville, TN 37996-0180

(865) 974-8184

CONSENT RELEASE FORM

I, (print name) ______________________________________ hereby give my consent

for photographing, filming, audio/videotaping, and/or direct transmission of television

signals of my image and voice, and release to The University of Tennessee all rights of

any kind to the materials in which I appear. This is a full release of all claims whatsoever

I or my heirs, executors, administrators or assigns now or hereafter have against The

University of Tennessee, or its employees, as regards to any use that may be made by

them of said photographic reproductions, films, audio/videotape, or direct transmission of

television signals.

Further, I acknowledge that my name and biographical material, portrait, picture,

likeness, or voice may be used for purposes consistent with The University of

Tennessee’s mission of teaching, research and service, including the promotion and

publicizing of the materials in which my image/voice appear. Such uses as may be made

will not constitute a direct endorsement by me of any product or service.

I have read this entire document, understand the contents, and I have willingly agreed to

the above conditions.

Date: _________________

Name (print): ________________________________________________

Address: ____________________________________________________

Signature: ___________________________________________________

Signature of Parent/Guardian (if under 18): ____________________________________

Consent Release Form