Photo Release Form Sample
THE UNIVERSITY OF TEXAS AT AUSTIN
UNIVERSITY INTERSCHOLASTIC LEAGUE
PHOTOGRAPHIC CONSENT AND RELEASE FORM
I hereby authorize the University of Texas at Austin and the University Interscholastic
League (University), and those acting in pursuant to its authority to:
(a) Record my likeness and voice on a video, audio, photographic, digital,
electronic or any other medium.
(b) Use my name in connection with these recordings.
(c) Use, reproduce, exhibit or distribute in any medium (e.g. print publications,
video tapes, CD-ROM, Internet/WWW) these recordings for any purpose that
the University, and those acting pursuant to its authority, deem appropriate,
including promotional or advertising efforts.
I release the University and those acting pursuant to its authority from liability for any
violation of any personal or proprietary right I may have in connection with such use. I
understand that all such recordings, in whatever medium, shall remain the property of the
University. I have read and fully understand the terms of this release.
Name: ____________________________________________________________
Address: ____________________________________________________________
Street
____________________________________________________________
City State ZIP
Phone: ____________________________________________________________
Signature: _________________________________ Date: __________________
Parent/Guardian Signature (if under 18):
_________________________________ Date: __________________
Revised July 2009
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