Publicity and Photo/Video Consent and Release Form

The University of Texas at Arlington (“UTA”) at times desires to use an individual’s name, likeness, image, voice, and/or appearance (the “Material”) to depict campus life, activities, interactions, etc. in any medium, including, but not limited to photographs, video recordings, audio tapes, digital images, advertising, brochures and other print images, and its social media content.
Select which department is taking your photo...
Which Department of the College of Liberal Arts
Permission To Use Statement

Permission To Use Statement I hereby grant UTA the irrevocable right and unrestricted permission to use, reproduce, print and/or publish the Material as such may be embodied in any photos, video recordings, audiotapes, digital images, and the like, taken or made on behalf of UTA. I agree that UTA has complete ownership of the Material and can use the Material for any purpose consistent with UTA’s mission. These uses include, but are not limited to, videos, publications, advertisements, news releases, web sites, social media, and any promotional or educational materials in any medium.
No Compensation Statement

No Compensation Statement I acknowledge that I will not receive any compensation for the use of the Material. I hereby release and discharge UTA from any and all claims and demands arising out of or in connection with the use of my name, likeness, image, voice, and/or appearance.
If the person signing is under the age of 18, consent from a parent or guardian is needed.

If the person signing is under the age of 18, consent from a parent or guardian is needed. Yes, individual is over the age of eighteen (18) years. Individual is not over eighteen (18), parent/guardian consent is needed.
Individual Release
Over 18 Statement

Over 18 Statement I represent that I am over the age of eighteen (18) years and that I have read the foregoing and fully understand its contents. This release shall be binding upon me, my heirs, legal representatives, and assigns. This agreement is being made and entered into under the laws of the State of Texas and shall be governed and interpreted in accordance with the laws of Texas.
Your Name Your Name First Last
Parent/Guardian Consent
Name (Being photographed, under 18) Name (Being photographed, under 18) First Last
Legal Guardian Statement

Legal Guardian Statement I hereby certify that I am the parent or legal guardian of the individual named above, and do hereby give my consent without reservation to the foregoing on behalf of this individual.
Parent/Guardian's Name Parent/Guardian's Name First Last
Parent/Guardian's Signature
Your Signature
Sign here:

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.
Date Date / MM / DD YYYY

Publicity and Photo/Video Consent and Release Form

Individual Release

Parent/Guardian Consent

Parent/Guardian's Signature

Your Signature