401 Golden Shore, 5th Floor, Long Beach, CA 90802-4210
562-951-4670 / Fax 562-951-4973
Visual/Audio Image Release Form
I grant permission to California State University, its employees and agents, to take and use
visual/audio images of me. Visual/audio images are any type of recording, inc luding but not limited to
photographs, digital images, drawings, renderings, voices, sounds, video recordings, audio clips or
acc om pan ying written descriptions. CSU will not materially alter the original images. I agree that
CSU owns the images and all rights related to them. The images may be used in any m anner or media
without notifying me, such as university-sponsored websites, publications, promotions, br oadcasts,
advertisements, posters and theater slides, as well as for non-university uses. I waive any right to
inspect or approve the finished images or any printed or electronic matter that may be used with them,
or to be compensated for them.
I release CSU and its employees and agents, including any firm authorized to publish, broadcast and/or
distribute a finished product containing the images, from any claims, damages or liability which I may
ever ha ve in c onnection with the taking or use of the images or printed material used with the images.
I am at least 18 years of age and competent to sign this release. I have read this release before
signing, I understand its contents, meaning and impact, and I freely accept the terms.
Name (please print)
Telephone or E-mail address
Signature of parent or guardian if under 18 years of age
[ ] Employee Campus ID# [ ] Student Campus ID# [ ] Community Member
Office Use Only:
(Photographer/Broadcast/Contact Information/Location/Notes/Photo Caption)