Photo/Media Release
Event_________________________________________
I (we) hereby authorize Clovis Community College and its contractors to make still photographs,
audio and video recordings, film, and/or digital images of my name, likeness and performance
taken on _______________________________(date). I (we) further consent that Clovis
Community College may use, or authorize others to use, all or portions of such photographs,
audio and video recordings, film, and/or digital images on its Web sites, in any or all of its print
publications, in its advertising or promotional material in any media or form, in educational
programs, or for any other purpose in any media now known or hereafter developed, throughout
the world in perpetuity. I authorize such recordings of my name, likeness and performance
without any monetary compensation and expressly waive any possible claims for damages or
remuneration in any form.
Name ________________________________________ Signature ______________________________________
(Name and signature of parent or guardian if under 18)
Parent/Guardian Name ___________________________ Signature ______________________________________
Address______________________________________________________________________________________
City__________________________________________ State_________________Zip______________________
Home Phone ___________________________________ Work Phone____________________________________
E-mail address ________________________________________________________________________________
417 Schepps Boulevard Clovis, New Mexico 88101-8381 575-769-2811 FAX 575-769-4190
