Photo & Video Release Form

I consent to being photographed, filmed, taped, or interviewed by representatives of Greenville University (GU) and hereby irrevocably grant GU permission in perpetuity to use my name, image, likeness, or voice (collectively the “Images”), including adaptations and derivative works of the Images, in any and all of its publications, in its website and any and all other media now known or hereafter developed, and for other use by the University including promotional purposes.

I waive any right to inspect or approve use of the Images. GU shall not owe me any compensation for use of the Images, nor is it obligated to use the Images. I hereby release and discharge GU, its trustees, officers, employees, licensees, and affiliates from any and all claims, actions, suit, or demands of any kind or nature whatsoever in connection with the use of the Images. This authorization is voluntary and is intended to be binding on my heir, successors, and assigns.

I am over the age of 18 (and, if I am not, this release has been signed by my parent or legal guardian).

Name of event or Requesting Department *

E.g Admissions, Athletics, Tour Day, Camp

Signature*

Clear

Full Name*

First NameMiddle NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Contact Number*

Area CodePhone Number

E-mail*

If the person signing is under age 18, there must be consent by a parent or guardian as follows:

I hereby certify that I am the parent or guardian of {fullName2}, named above, and do hereby give my consent without reservation to the foregoing on behalf of this person.

Signature

Clear

Date

Name

First NameLast Name