Talent release form for minors
Video/Photo/Audio Consent Form
I, the undersigned, do hereby consent to the use by the University of Illinois at Urbana-Champaign of
the image, voice, or both of the minor child under the age of 18 described below, in (1) the video,
photograph, or audio recording described below; and (2) any video, photograph, or audio recording
reproduced either in whole or in part from the video, photograph or audio recording described below:
regardless of whether these materials are used for fundraising, advertising, publicity, or any other
purpose on behalf of either the university or its Foundation.
I warrant that I am the parent or legal guardian of the minor described below and have the full right
and authority to grant this consent on behalf of such minor.
In addition, I waive all claims to compensation or damages based on the use of such minor’s image
or voice, or both, by either the university or the Foundation. I also waive any right to inspect or
approve the finished photograph or video or audio recording.
I understand that this consent is perpetual, that I may not revoke it, and that it is binding on the minor,
our heirs and assigns.
I warrant that I am at least 18 years of age and that I am competent in my own name insofar as this
consent is concerned. I further attest that I have read this consent form and fully understand its
contents.
Description of video, photograph, or audio recording:
________________________________________________
________________________________________________
________________________________________________
Printed name of minor:
________________________________________________
Age of minor:
________________________________________________
Address of minor:
________________________________________________
Signature of parent or legal guardian:
________________________________________________
Printed name of parent or legal guardian:
________________________________________________
Address of parent or legal guardian:
________________________________________________
Date:
________________________________________________
Name and address of photographer/videographer:
________________________________________________
________________________________________________
2/2/2006 Form