Photo/Video Release Form

Release Information

For good and valuable consideration, receipt of which is hereby acknowledged. I consent that Nipissing University, their legal representative, successors or assigns, shall have the absolute right and permission to copyright, publish, use sell or assign any and all photographic, portraits, pictures or video of me taken on this date, or provided by me, whether apart from or in connection with illustrative of written matter, story or new items or for trade, advertising or for any other purpose in conjunction with my own or a fictitious name, or in reproductions thereof in colour or otherwise.

Model's Name (First & Last)

Guardian (If model is under 18 years)

Phone

I hereby release, discharge, and agree to save harmless their legal representatives or assigns and all persons acting under their permission or authority or those for whom they are acting, from any liability by virtual of any blurring, distortion, alteration, optical illusion or use in composite from, whether intentional of otherwise, which may occur or be produce in the taking of said picture or video and the publication thereof.

I hereby waive any right that I may have to inspect and/or approve the finished product or the advertising copy that may be used in connection therewith or the use to which it may be applied.

I hereby warrant that I am of full age and have every right to contract in my own name in the above regard. I state further that I have read the above authorization and release, prior to its execution and that I am fully familiar with the contents thereof.

Photo/Video Release Form

Students

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