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Photographic Consent and Release Form

I hereby authorize Loyola Marymount University and those acting pursuant to its authority (“university”) to:
  • Record my likeness and voice on a video, audio, photographic, digital, electronic or any other medium; and
  • Use my name in connection with these recordings; and
  • Use, reproduce, exhibit or distribute in any medium (e.g., print publications, video tapes, CD-ROM, Internet) these recordings for any purpose that the university deems appropriate, including promotional or advertising efforts.
Any copyrights arising from the aforementioned uses shall remain the sole property of the university. I waive my rights to any and all claims for payment in connection with this authorization and release. I release the university 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, are, and shall remain, the property of the university. I have read and fully understand the terms of this release. If this release involves a minor (anyone under 18), my signature waives all claims on his/her behalf. This release is governed by the laws of the State of California.

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First Name
Last Name
Street Address
City
State
Zip Code
Primary Phone
 
Email
 
Electronic Consent: By entering my name below, I hereby provide my digital signature and consent for this release (as provided by the ESIGN Act and UETA). Enter your first and last name:
Signature Date
Pick date
Signature
By checking this box, I signify that I have read, understood and agree to the terms and conditions of this release. If the person referenced above is under 18, then I certify that I am a parent or legal guardian who waives all claims on his or her behalf.
 



Thank you.  When you have completed all of the fields and indicated your agreement by checking the signature box, click the Submit button to complete the release form.