Utah Tech University Photo Release Form

Utah Tech University Photo Release Form
Name*

First NameLast Name
Age*

Under 1818+ years
Date*

MonthDayYear
HOMETOWN*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Phone Number*

Area CodePhone Number
I hereby consent to the use, reproduction, editing and/or broadcast by Utah Tech University of any and all photographs, video recordings and audio recordings of me taken by or on behalf of Utah Tech University without compensation to me. All digital negatives and positives, prints, video-recorded images and audio recordings shall constitute the property of Utah Tech University solely and completely. I also consent to the use of the above information for promotional purposes.*

Yes, I consentNo
Signature*

Clear
IF UNDER 18, PLEASE PROVIDE DIGITAL SIGNATURE OF PARENT OR GUARDIAN I hereby consent to the use, reproduction, editing, and/or broadcast by Utah Tech University of any and all photographs, video recordings, and audio recordings of my dependent taken by or on behalf of Utah Tech University without compensation. All digital negatives and positives, prints, video-recorded images, and audio recordings shall constitute the property of Utah Tech University solely and completely. I also consent to the use of the above information for promotional purposes.
Parent or Guardian Signature

Clear
Should be Empty: