Student School Video Release Form

STUDENT SCHOOL VIDEO RELEASE FORM

Student Information

Date of Birth:   Student ID:

Parent / Guardian Information (If student is under 18)

I certify the student is 18 years of age or older and is signing on their own behalf.

Relationship:   Phone:

Production / Project Details

Recording Date(s):   Location:

Intended Uses (check all that apply):

Educational instruction and classroom use
School publications, brochures, yearbook
School website or official social media accounts
Broadcast or news media
Promotional/fundraising materials
Other:

Release Terms and Conditions

Grant of Rights: I hereby grant to the School and its agents, licensees, successors and assigns the irrevocable, perpetual, worldwide, royalty-free right to record, edit, publish, distribute, display, reproduce and otherwise use my and/or my child's image, likeness, voice and performance (collectively, the Recording), in whole or in part, in any media now known or hereafter devised, for the purposes described above and for other educational, promotional or archival purposes as determined by the School.

Waiver of Compensation: I agree that I will not receive any compensation, remuneration or other consideration for the use of the Recording and hereby waive any right to inspect or approve finished materials incorporating the Recording.

Release and Indemnity: I release and discharge the School and its officers, employees, representatives, licensees and assigns from any and all claims, demands, causes of action, liabilities or damages arising out of or related to the use, alteration, distribution or exploitation of the Recording, including claims for invasion of privacy, defamation, or violation of any publicity rights. I agree to indemnify and hold harmless the School from any claims relating to the Recording arising out of my breach of this Release.

Editing and Derivative Works: I acknowledge that the School may edit or combine the Recording with other images, audio or text, and I waive any moral rights or claims based on such alterations or combinations.

Revocation: I understand that this Release is intended to be continuing and irrevocable as to uses already made; any request to revoke permission must be submitted in writing to the School and will not affect uses made prior to receipt of such request.

Authority to Consent: If signing for a minor, I certify that I am the parent or legal guardian of the listed student and have full authority to grant the rights contained herein. I warrant that there are no other persons whose consent is required to grant these rights.

Governing Law: This Release shall be governed by and construed in accordance with the laws of the state in which the School is located, without regard to conflict of laws principles.

Medical / Emergency Information

Relationship:   Phone:

Acknowledgment and Certification

By signing below I acknowledge that I have read and understand this Release in its entirety, that I am at least 18 years of age or am the parent/legal guardian of the student identified above, that I have the legal authority to execute this Release, and that this Release contains the entire agreement between the parties with respect to the Recording.

I further certify that all information provided on this form is true and correct to the best of my knowledge.

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