Please fill out completely and sign at the bottom.
NAME: ________________________________________________________________________________________
ADDRESS: ________________________________________________________________________________________
PHONE: _____________________________ EMAIL: ____________________________________________________
EVENT/CLASS TITLE: ________________________________________________________________________________
I hereby agree that the District Board of Trustees of Palm Beach State College (the “College”), and those acting pursuant to
its authority, shall have the right to record my participation, appearance, likeness and voice on videotape, audiotape,
photograph, digital, electronic or in any other medium and I hereby unconditionally and irrevocably consent to the College’s
use of such materials for any legal purpose the College deems appropriate for the benefit of the College, including commercial
and advertising purpose also, I hereby forever waive (i) any right to require payment from the College for the use of these
materials by it or those acting pursuant to the College authority and (ii) the right to object to the use of such materials for
any purpose permitted by this Consent and Release, including, without limitation, the license or sale of such materials by the
College and those acting pursuant to its authority who publish, print, display, exhibit, distribute or otherwise publicly use any
such materials for any legal purposes. I understand the foregoing consent and release grants the College the right to edit,
crop, retouch, or otherwise reasonably alter such materials, at its discretion, and, at its option, to reveal my name and identity
in such materials or by descriptive text or commentary. I understand and agree that any intellectual property rights associated
with such materials are the sole property of the College. Furthermore, I agree that this release shall be construed in
accordance with the laws of the State of Florida and if any term or provision of this release shall be held illegal, unenforceable,
or in conflict with any law governing this release, the validity or enforceability of the remaining portions shall not in any way
be affected or impaired thereby.
SIGNATURE (required): ______________________________________________ DATE: __________________________
CRM_ModelRelease_02052018_KF
