Lecture Capture Consent and
Release Form
I (the undersigned) understand and agree that comprehensive course materials including, but
not limited to, text, graphic designs, images, video, and audio files of students in the course will
be collected and preserved and that I was made aware of this fact by the course instructor at
the beginning of the term.
I authorize the recording of my image, likeness, voice, presentation and/or course work on a
photographic, video, audio, digital, electronic, or any other medium. I also authorize the use of
my name in connection with any such recordings or uses.
I hereby grant to Henry Ford College a non-exclusive license and right to use my image,
likeness, voice, name, excerpts or portions of my audio or videotaped coursework (e.g.,
student presentation, small group discussion or comments in a seminar format) in which I am
portrayed for educational or noncommercial-related purposes. I understand I have no property
interests in such recordings and/or uses. I further understand that I will receive no money or
remuneration of any kind from Henry Ford College related to this consent and release or the
materials covered by this consent or release. I acknowledge that I do not have the right to
inspect or approve any materials developed by the College.
This release and consent includes the right for the College to:
1. Make and copyright text, photographs, audio and/or video recordings of my image, voice
and course work, as part of the Henry Ford College’s lecture capture program.
2. Use, produce, modify, distribute, and disseminate such materials in any form, manner, or
mode of electronic transmission for educational or non-commercial-related purposes,
including, without limitation:
a. Access for HFC students, including, but not limited to, classroom use; posting to
password-protected course management systems, internet sites or blogs; and
preservation in Henry Ford College’s archives.
b. Henry Ford College promotional and advertising efforts, including, without
limitation, posting to Henry Ford College’s website, inclusion in Henry Ford College
catalogs and brochures, or any other public use or display.
I release Henry Ford College and those acting pursuant to its authority, including, without
limitation, its elected officials, officers, employees, work study and co-op students and agents
from any alleged violations of any privacy, property and/or proprietary rights I may have related
to such recordings and uses.
I hereby certify and represent that I am over 18 years of age and have read the foregoing and
fully understand the meaning and effect of this Consent and Release form. In the case of a
child under the age of 18, I state that I am the parent, guardian, or otherwise legally authorized
adult capable of giving consent on behalf of the minor child.
Lecture Capture Consent and
Release Form
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Student Signature: Date:
Printed Student Name:
HANK ID Number:
Guardian Signature: Date:
Printed Guardian’s Name:
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