Photograph and video release form
Release
For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby consent to the photographing of myself and the recording of my voice and the use of these photographs and/or recordings singularly or in conjunction with other purposes. I understand that the term "photograph" as use herein encompases both still photographs and the motion picture footage.
I further consent to the reproduction and/or authorization by Replimat LLC to reproduce and use said photographs and recordings of my voice, for use in diverse educational settings including online videos. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording.
I grant permission for this video to be uploaded to Replimat's public YouTube account or other public online video repository (initial one of the following options):
- ___ immediately
- ___ after this date: ______________
- ___ never (for internal use only)
This release applies to photographic, audio or video recordings collected as part of the sessions listed on this document only.
By signing this form I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for educational purposes.
Recording session name and date
- Full name: _______________
- Email: _________________
- Signature: _______________
- Date: ______________
If this release is obtained from a presenter under the age of 19, then the signature of that presenter's parent or legal guardian is also required.
- Parent's signature: __________________
- Date: _______________
