Video Release Form

Release & License to Use Image, Name &/or Voice

Instructions

Use the Release & License to Use Image, Name &/or Voice to obtain permission from individuals to use their image or visual likeness, their name, and/or their voice in University publications or other productions. If this Release is being granted with respect to a minor, it is necessary to first obtain the prior consent of the minor’s parent(s) or legal guardian(s). Contact UCSB Risk Management for additional information.

Department: Associated Students

Class/Activity: Community Affairs Board

I, the undersigned, hereby grant the Regents of the University of California (“University”) permission to use, exploit, adapt, modify, reproduce, distribute, publicly perform and display, in any form now known or later developed, my image or visual likeness, my name and/or my voice (the “Personal Information”) as specified in this Release and indicated above, throughout the world, by incorporating it or them into publications, catalogues, brochures, books, magazines, photo exhibits, motion picture films, internet websites, videotapes, and/or other media (the “Works”) or commercial, informational, educational, advertising, or promotional materials relating thereto.

I release, and hereby agree to indemnify, defend, and save harmless University, its agents, employees, licensees and assigns (collectively, “Released Entities”) from any and all claims I, or any third party, may have now or in the future for invasion of privacy, right of publicity, copyright infringement, defamation or any other cause of action arising out of the use, exploitation, reproduction, adaptation, distribution, broadcast, performance or display of the Personal Information.

I waive any right to inspect or to approve any Works that may be created using the Personal Information and waive any claim with respect to the eventual use to which the Personal Information may be applied. The Personal Information may be used at the University’s sole discretion, with or without my name or with a fictitious name, and with fictitious or accurate biographical material, alone or in conjunction with any other material of any kind or nature except that University will not use the Personal Information for any criminal or illegal purposes or in a manner inconsistent with community standards of decency.

I understand and agree that University is and shall be the exclusive owner of all right, title, and interest, including copyright, in the Works, and any commercial, informational, educational, advertising, or promotional materials containing the Materials.

I am of full legal age and have read this release and am fully familiar with its contents. By their signature below, a minor’s parent(s) or legal guardian(s) indicate, on behalf of their minor child, their full and unqualified consent to the terms of this Release & License.

This Release & License is for the following Personal Information:
(Check all Personal Information for which permission to use is being given)
Participant Name(Required)
Parent/Guardian Signature (if minor)

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