UTC Photo Video Release Form
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URL of this online form is https://tinyurl.com/photo-rele
Email *
Photo/Video Release form
I give permission to The University of Tennessee at Chattanooga to use my likeness in all forms and media for advertising, trade, and any other lawful purposes.
I hereby irrevocably consent to and authorize The University of Tennessee at Chattanooga (herein "UTC"), or anyone/or organization authorized by UTC, the absolute and irrevocable right and unrestricted permission concerning any photographs and/or video that UTC has taken or may take of me or in which I may be included with others, to use, reuse, publish, and republish the photographs now or hereafter known, including the internet, and for any purpose whatsoever, without restriction as to alteration, in connection with any use if UTC so chooses, without any compensation to me. I release and discharge UTC from any and all claims and demands that may arise out of or in connection with the use of the photographs and/or video, including without limitation any and all claims for libel or violation of any right of publicity or privacy. This authorization and release shall also insure to the benefit of the heirs, legal representatives, licensees, and assigns of UTC, as well as person(s) for whom took the photographs and/or video. No further claim of any kind will be made against UTC, its associates, and/or clients in regards to this photograph/videography contract. All photographs and/or video will be copyrighted, owned, and controlled by UTC. I am a legally competent adult and have the right to contract in my own name, or I am a parent or legally appointed guardian of the minor and I have every right to contract for the minor in the above regard. I have read this document and fully understand its contents. This release shall be binding upon me and my heirs, legal representatives, and assigns.
Model Signature (Parent or legal guardian if Model is a minor) *
Please type your full name as an online signature. Model refers to a participant in the online coding bootcamp
Model Name
Please type the full name of the Model if this form is filled by a parent/guardian.
Model Email Address *
Please type the email address of the Model (Participant of the coding bootcamp)
Model Home Address *
Please type your full address
Please indicate the date that you filled this online form
This release form is for the online student coding bootcamp December 19-23, 2020
For more information about this event, please email Prof. Hong Qin,   hong-qin@utc.edu
A copy of your responses will be emailed to the address you provided.
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