Photo/Video Consent and Personal Identification Form for Minors
This form must be completed by the legal guardian of a photo/video subject who is under the age of 18.
Sign in to Google to save your progress. Learn more
Email *

By submitting this form, I agree to terms & conditions. 


I authorize Portland State University (University) to: 1. Record my minor child's likeness and voice on a video, audio, photographic, digital, electronic or any other medium (hereafter the “Recordings”). 2. Use my minor child's name in connection with these recordings. 3. Use, reproduce, exhibit or distribute to any person, including the general public, and in any medium (including print publications, University webpages, digital videos and other internet or social media postings such as YouTube, Facebook, Instagram, Flickr, etc.) these recordings for the purposes of promoting the University. As the Legal Guardian, I release the University and those acting pursuant to its authority from liability for any violation of any personal or proprietary right I may have in connection with such use. I waive any right to inspect and/or approve the finished product, or the use to which it may be applied.

I recognize and authorize that release of these Recordings may often be made to, and used by the public news media or other entities over which the University has no control; and for which the institution bears no responsibility. I understand that all such Recordings, in whatever medium, shall remain the property of the University.

This release will remain in effect unless and until revoked by me in a written communication submitted to the University via email at ucomm@pdx.edu. 

If I revoke my consent, I understand the University will not use the Recordings for any purpose after my consent is revoked.  I further understand that the University may not be able to stop any use that was made prior to me revoking my consent.

I have read and fully understand the terms of this release.

*
Project or Event Name

information and/or Identifying information.

What does child your look like? What clothes was the child wearing? Where or what were the shots taken for?
*
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Portland State University.

Does this form look suspicious? Report