Video/Photograph Release Form

Andrews Student Recreation
and Wellness Center

Video/Photograph Release Form

Kindly sign this form giving us permission to use any videos/photographs taken at this event.

I hereby give Youngstown State University the right and permission to publish or use video, photographic portraits or pictures of me, or in which I may be included in whole or in part, or composite or distorted in character or from, in conjunction with my own fictitious name, or reproductions thereof, in color or otherwise, for art, advertising trade or for an other lawful purpose whatsoever.

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

I hereby release, discharge, and agree to save Youngstown State University from any liability by virtue of any blurring, distortion, alteration, optical illusion or use in composite/electronic form whether intentional or otherwise that may occur or be produced in the taking of said video or pictures, or in any processing tending towards the completion of the finished product.

Take Your Child to Work

Child(s) Name(s):

Parent/Guardian (If child is under 18 years of age):

Date: