Photo Release Form for iMakerSpace

Office of Communications & Marketing
Box 5056 . Cookeville, TN 38505-001 . (931) 372-3214 . Fax (931) 372-6138
tntech.edu/ocm

Consent

Intending to be legally bound, I do hereby irrevocably consent to and authorize Tennessee Technological University, its officers, employees and agents, (the "University") to use existing photographs, photograph, video tape, record, publish, re-publish, broadcast, re-broadcast, adapt, exhibit, perform, reproduce, edit, modify, make derivative works, distribute, display or otherwise use or reuse my name, image/likeness or voice in any media or technology now known or hereafter developed in connection with any product or service or promotional or informational campaign undertaken by the University in all markets as long as there is no intent to use the image, voice and/or likeness in a disparaging manner. University may exercise any of these rights itself or through any successors, transferees, licensees, distributors or other parties, commercial or non-profit.

Please indicate your agreement to the foregoing by signing below.
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Today's Date Today's Date / MM / DD YYYY
Your Name Your Name First Last
Your Email
If you are under eighteen (18) years of age, your parent or guardian mush sign below:

I represent that I am a parent/guardian of the minor named below and that in that capacity University has my consent and authorization to use the name, voice and/or likeness as described above.
Name of Minor Name of Minor First Last
Parent/Guardian:
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Parent/Guardian Name Parent/Guardian Name First Last
Date Date / MM / DD YYYY

Photo Release Form for iMakerSpace

Photo Release Form for iMakerSpace

Consent

If you are under eighteen (18) years of age, your parent or guardian mush sign below: