Band Member for a Day - Photography/Video/Media Consent and Release Form

I hereby consent and authorize an employee or agent of Arkansas Tech University to take photographs or motion pictures of me; or to produce videotapes, digital recordings, digital video, audiotapes, closed circuit television programs, web casts, or other types of media productions that captures my name, likeness, voice, and/or image (any of the foregoing types of media are called the "materials" in this Consent and Release form).

I authorize Arkansas Tech University to copyright the materials, and I authorize Arkansas Tech University to use, re-use, copy, publish, display, post, exhibit, reproduce, license to a third party, or distribute the materials which bear my likeness in any educational or promotional materials, or other forms of media, which may include, but are not limited to, university publications, catalogs, articles, magazines, recruiting brochures, posting to websites, or other electronic forms of media. In addition, Arkansas Tech University may offer the materials for use or distribution in other publications, electronic or otherwise, without notifying me.

By choosing "Yes", I also agree that in the use of the materials, Arkansas Tech University may identify me by name, hometown, etc,:

Yes

No

Initial Here:

I agree that I am participating on a voluntary basis and I will not receive any payment from Arkansas Tech University for signing this release or as a result of any publication of the materials. Further, I understand that I am knowingly waiving any and all rights that may available to me under the Frank Broyles Publicity Rights Protection Act of 2016.

Student First Name:

Student Last Name:

Student DOB:

Student Email Address:

Signature (Parent/Guardian Signature if less than 18 years of age):

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Date: