202 South Halsted Street | Chicago
Heights,
IL 60411 | (708) 709-3500 |
pr
air
iestate
.edu
In consideration for ________________________ (“Participant”) being allowed to participate in the
activity/event at Prairie State College (“College”), Participant, hereby grants permission to the college to
use participant’s photograph, video, or likeness on its website or in any other publication used for the
college. Participant acknowledges the college’s may crop or treat the photograph or video at its sole
discretion. Participant acknowledges the college’s right to use this photo or video at any time. Participant
hereby waives any right that he/she may have to inspect or approve the finished product or the use to
which it may be applied. Participant hereby waives all rights to receive compensation in connection with
the taking and use of participant’s photograph or videotaped image by the college, its agents, successors
and assigns, and all persons acting with its permission or upon its authority.
By signing below, the undersigned hereby acknowledges that he or she has read and understands the
contents of this document.
Date:
Name of Participant:
Address:
Phone number:
Email:
Signature of Participant:
For Minor Photo Subjects:
I hereby affirm that I am the parent/guardian of the above named Participant, I am over
the age of 18, and I hereby consent to the use of the photograph of said Participant.
Signature (of parent/guardian):
Date:
☐ By checking this box and typing my name below, I am electronically signing this Photo/Video Release
Form. I understand that an electronic signature has the same legal effect and can be enforced in the same
way as a written signature. I further attest that I am the individual identified in this form and, if applicable,
am the parent or guardian of the minor being released.
Signature: ___________________________________
5/17
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