University Relations

Carriage House
UC Santa Cruz
1156 High Street
University of California
Santa Cruz, CA 95064-1077
Email: urrecept@ucsc.edu
Phone: (831) 459-2501

Web:


UCSC Photo Release - Group

I give the University of California, Santa Cruz, the absolute right and permission to use my photograph in its promotional materials and publicity efforts. I understand that the photographs may be used in a publication, print ad, direct-mail piece, electronic media (e.g., video, CD-ROM, Internet/WWW), or other form of promotion. I release the university,the photographer, their offices, employees, agents, and designees from liability for any violation of any personal or proprietary right I may have in connection with such use. I am 18 years of age or older.

Course Title & Number _______________________________________________________

Instructor's Name _________________________________________________________

Signature __________________________________

Students:

Print Name                     Signature                     Date

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Please return completed form(s) by campus mail to: Jim MacKenzie/Publications Office/University Relations/Carriage House.

[ View / Download PDF version of this form ]