NDCS Photo Release

NEBRASKA DEPARTMENT OF CORRECTIONAL SERVICES MEDIA RELEASE FORM
RELEASE FOR VOLUNTEERS AND GUESTS
I, (Participant)

Legal First NameLegal Last Name
Event
Enter: "RISE Event", Date of Event, Facility Name
voluntarily give my consent to the Nebraska Department of Correctional Services, its facilities, employees and officials to take and use photographs, video, digital images and/or recorded voice for use in publicity, illustration, publishing, and other lawful purposes as to be determined by NDCS.

I further agree that my name and identity may be revealed in descriptive text or commentary in connection with the use of such image(s I authorize the use of these images indefinitely without compensation to me. All negatives, prints, digital reproductions, video and audio recordings shall be the property of NDCS.

Additionally, I grant permission for authorized representatives of the Nebraska Department of Correctional Services to release to representatives of the news media any comments made by me during an interview.
Signature

Clear
Date

MonthDayYear
Date
If you are not accompanying a minor, please scroll to the bottom and submit this form.
RELEASE FOR MINOR CHILDREN (Under 19)

If you are not accompanying a minor, you will skip this section.
I,

First NameLast Name
parent or legal guardian of

Minor Legal First NameMinor Legal Last Name
hereby grant permission to NDCS, its facilities, employees, and officials, to take and use photographs, video, digital images and/or recorded voice for use in publicity, illustration, publishing, and other lawful purposes as to be determined by NDCS.
I agree that my child(ren)'s name and identity:

may be revealedmay NOT be revealed in descriptive text or commentary in connection with the use of such image(s)
I authorize the use of these images indefinitely without compensation to me. All negatives, prints, digital reproductions video and audio recordings shall be the property of NDCS.
Signature

Clear
Date

MonthDayYear
Date
DCS-A-adm- 109 (rev.4/2023) Printed from Agency shared drive. Policy 002.01 Attachment B
Should be Empty:

NEBRASKA DEPARTMENT OF CORRECTIONAL SERVICES MEDIA RELEASE FORM

RELEASE FOR VOLUNTEERS AND GUESTS

If you are not accompanying a minor, please scroll to the bottom and submit this form.

RELEASE FOR MINOR CHILDREN (Under 19)