I, the student, consent to the release, exhibition, and distribution; without charge and without restriction or limitation; photographs of my likeness during my participation in the UHS program for any communications, educational, marketing, advertising, publicizing, promotional, and/or any other purpose which the releasees deem appropriate. I release the releasees from any and all types of claims and liability including without limitation for negligence or invasion of privacy of any and all types.
For purposes of this paragraph, “Photographs” include videotape, audio tape, film, photograph, electronic data or image, and/or any other recording medium. For purposes of this paragraph, “Likeness” includes my name, likeness, voice, biographical material, and/or other private and/or public facts and/or opinions. This authorization represents my written consent to disclose information from my experience to anyone the releasees see fit, including SUU Administrators, SUU and local media outlets, marketing materials, etc.
I understand that I may opt out of, or add limitations to, with no retroactive application, these provisions. To do so, I understand that I must fill out and sign the second page of this document and submit it to the Utah Health Scholars Office by email to firstname.lastname@example.org.
I understand that this form may be signed digitally. By signing digitally, I certify that I have read, understand, and agree to all of the above. If not signing digitally, I will sign the on the provided line below to certify that I have read, understand, and agree to all of the above.