Location Release Form
Address City State Zip
First Name Last Name Signature
Email Telephone Date
By signing above, you are acting as an oicial representative of the above mentioned company and acknowledge that images/video being taken may feature company building(s), equipment, signage
and brandmarks. The information above is kept confidential. The University will not sell photo/video footage to any third party. Images are protected under copyright of Lesley University.
Date of Shoot ☐ Photography ☐ Videography For Internal Use Only
As an official representative of (company name) I hereby declare that all photo and video
footage which was captured on the property listed below by Lesley University was done with my complete approval. Any and all images/footage related
to this photo/video shoot may now or in the future be used by Lesley University for promotional purposes in University publications, advertising, video,
web, social media, or other formats without notifying me. I understand that I hereby waive the right to review these materials before publication or bring
suit for copyright infringement and that Lesley University does not owe my company any compensation for use of these images.
Email completed form to firstname.lastname@example.org
Lesley University Office of Communications and Marketing
29 Everett Street, Cambridge, MA 02138
email@example.com ◆ lesley.edu