Campus Recreation Media Request Form
To protect the privacy of our participants, the use of photographic devices, including cell phone cameras and professional equipment, is not permitted at Campus Recreation facilities without prior permission from the Department of Campus Recreation. Permission may be requested by submitting a Media Request Form.
By submitting a Media Request Form, you understand that:
1. The form MUST be completed a minimum of 1 full business day in advance to your requested day/time.
2. Filling out this form does NOT guarantee approval for your request. You will be emailed regarding the status of your request.
3. If approved, you MUST inform anyone who appears in the photos/videos and receive his/her verbal consent prior to photographing/videoing. Violation of this requirement may result in the requestor presenting his/her media to a Campus Recreation staff member and/or the requestor being asked to discontinue photography/videography.
4. If approved, all photography/videography must be taken between the hours of 8am-2pm Monday-Friday.
5. If approved, Campus Recreation should receive access to all photographs/videos taken if requested.
* Required
Name
*
Your answer
Email address
*
Your answer
Phone number
*
Your answer
What is your affiliation with the University of Mississippi?
*
Enrolled student
Faculty/staff
Not affiliated
UM ID number
Your answer
Select your media request(s)
*
Photography
Videography
Staff interview
Other
Required
Who do you want to interview, photograph, or video? Please request a specific person(s) if possible.
*
Your answer
What is the purpose of your request? (i.e. to take pictures of someone engaging in physical activity and ask them a few questions about their workout routine for my journalism class)
*
Your answer
Location(s) for request (i.e. fitness center, lobby, etc.)
*
Your answer
Media request date(s)
*
Your answer
Media request time(s):
*
8am-8:30am
8:30am-9am
9am-9:30am
9:30am-10am
10am-10:30am
10:30am-11am
11am-11:30am
11:30am-12pm
12pm-12:30pm
12:30pm-1pm
1pm-1:30pm
1:30pm-2pm
Other (note: only for special situations)
Required
If you indicated "other" for the media request time, please explain
Your answer
What will your produced media be used for?
*
Your answer
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