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Photograph & Video Release Form

 
I hereby grant temporary permission to the rights of my image, likeness and sound of my voice as recorded on audio or video tape without payment or any other consideration.  I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording.  I also understand that this material may be used in diverse educational settings within an unrestricted geographic area. 

Photographic, audio or video recordings may be used for the following purposes:

conference presentations
educational presentations or courses
informational presentations
on-line educational courses
educational videos

By signing this release I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the Internet or in the public educational setting.

I will be consulted about the use of the photographs or video recording for any purpose other than those listed above.

There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.

This release applies to photographic, audio or video recordings collected as part of the sessions listed on this document only.

By signing this form I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for educational purposes.

Full Name___________________________________________________

Street Address/P.O. Box________________________________________

City _______________________________________________________
 
Prov/Postal Code/Zip Code______________________________________

Phone  ___________________________ Fax _______________________

Email Address________________________________________________

Signature____________________________ Date____________________________

If this release is obtained from a presenter under the age of 19, then the signature of that presenter’s parent or legal guardian is also required.

Parent’s Signature_____________________ Date____________________________