UAF model release
Please fill out the information below, read the "Model Release" language on the second page and then affirm that you agree to those terms. That affirmation will serve as your electronic signature and by completion of this form you agree to the use of electronic signatures for this consent agreement. If you are under 18, a parent or guardian will need to sign for you.
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Email *
First name of the person who was filmed, photographed or recorded. *
Last name of the person who was filmed, photographed or recorded. *
Mailing address
Phone number
How are you affiliated with UAF? *
If you are a student, what is your major? Are you an undergraduate or graduate student?
If you are not a student, write "NA."
Who is signing this form? *
Write "Self" if you are over 18 and signing for yourself. If you are signing on behalf of a minor, please enter your name here.
Model release
By signing, I give the University of Alaska Fairbanks and its partners, agents, subsidiaries, affiliates, licensees, successors-in-interest, and assigns, collectively “UAF,” perpetual permission to take photographs, audio recordings or video of me and to use the photographs, video and/or audio recordings, and my student directory information or publicly releasable employee information, including name, academic class standing and major, in its print and electronic publications or productions, including advertising, signage and promotional materials, in any and all media now known or hereafter devised. I assign all rights, title and interest I may have in any photograph, audio recording or video to UAF. I agree that the photographs, audio recordings and video are the property of UAF and hereby release UAF from any and all claims that I may have from its use of my image, voice, name or likeness including, but not limited to, any claim for compensation.

I have read this model release and I understand all its terms and conditions.  

Please confirm that you are the person who appears in the recorded video or audio, or photograph, or are a parent or legal guardian for the person appearing therein. *
I have read the Model Release and affirm that I agree to the terms therein. By signing, I acknowledge my identity for the purpose of the execution of this release. *
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