Media Release Form

Media Release Form
By signing this release, you consent to be interviewed, photographed, videotaped, or recorded while participating in activities at Waldorf for the purpose of creating promotional content, news releases, or other publications for Waldorf University. All media collected will be the exclusive property of Waldorf University.

I agree that Waldorf may also use photographs and/or media provided by me, my name, for any lawful purpose, including publicity, illustration, advertising, and web content. Author/creator attribution will be included whenever possible, practical, and known.
Date

MonthDayYear
Date
Name of Releasor

First NameLast Name
Email of Releasor
example@example.com
Phone Number of Releasor
Age of Releasor
Address of Releasor

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Item(s) for release
Please add brief description of the event, item, session, etc. you’re providing this release for.
File Upload

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WAIVER

I grant Waldorf University, its representatives and emploees the right to take and use media (photograph image and/or video footage and/or audio recordings) in connection with the above-identified subject.

I likewise understand that I may be identifiable from the reproduction of the media by the Releasee indicated herein in this agreement.

I authorize Waldorf University to copyright, use and publish the same in print and/or electronically.

I agree that Waldorf University may use such media of me with or without my name for any lawful purpose, including, for example, purposes as publicity, illustration, advertising, and web content.

I hereby waive my rights to inspect or approve the media for production that may be used by the Releasee for purposes stated herein, from hereon forward.

I likewise waive any right to royalties or any compensation arising from or related to the use of the image.
I certify that I am of legal age and competent to contract in my own name. I have read this release before signing below and I fully understand the contents, terms, and the effect of this release.
I am the parent or legal guardian of the named minor in this agreement. I have read this release before signing below, and I fully understand the contents, terms, and the effect of this release.
Date

MonthDayYear
Date
Signature of Releasor or Releasor's Guardian

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