K-12 Outreach/UAF Model Release Form
Please fill out the information below. Read the "Model Release" language at the bottom and then affirm that you agree to those terms. This 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 (person being photographed, filmed or recorded)
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Last Name (person being photographed, filmed or recorded)
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Mailing Address
Phone Number
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Which program are you affiliated with? Media could be used across K-12 Outreach programs and UA general media. Noting which program you're a part of is solely for our own record keeping purposes.
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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. *
Relationship to minor (write NA if you are over 18 years old):
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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.

I have read the Model Release and affirm that I agree to the terms therein. By typing my name, I acknowledge my identity for the purpose of the execution of this release.Type below to sign.
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