UCSC Photo/Video Release (under 18 years old)

I, (parent's name, please print) ______________________________________________ , give the University of California, Santa Cruz, the absolute right and permission to use a photograph(s) and/or video(s) of my [_] son [_] daughter in its promotional materials and publicity efforts. I understand that the photograph(s) and/or video(s) may be used in a publication, print ad, direct-mail piece, electronic media (e.g. video, CD-ROM, Internet, World Wide Web), 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.

Name of subject ____________________________________________________

Signature _________________________________________________________

Address ___________________________________________________________

City ____________________________________ State _______ Zip __________

Phone (_______) _____________________________ Date __________________

Email _______________________________________

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