Image Consent Form

SUBJECT INFORMATION
First & Last Name: First & Last Name: First Last
Today's Date: Today's Date: / MM / DD YYYY
Email Address:
Position:

Position: Visitor Student (under age of 18) Student (18 or older) Alumnae/i Faculty Staff Other Other
UNDER 18? If you are under 18, your parent/guardian is required to sign for consent. Type the name of the consenting adult below. UNDER 18? If you are under 18, your parent/guardian is required to sign for consent. Type the name of the consenting adult below. First Last
College or Affiliation:

College or Affiliation: Visitor / No Affiliation Undergraduate The College of Organizational, Computational, and Information Sciences The College of Natural, Behavioral, and Health Sciences The College of Social Sciences, Policy, and Practice The Gwen Ifill College of Media, Arts & Humanities Other Other
Name of Event (if applicable):
Hosting Department/Office (for events)

Select which department or office is hosting the event.

If you are unsure of this, please select University Communications.
AGREEMENT

Terms of Agreement:

I understand that Simmons University is undertaking initiatives to promote the University, its colleges, and its programs, and I wish to assist the University and its authorized agents. I understand that by participating:

1. If I am participating in a photoshoot undertaken by Simmons, I grant Simmons University and its authorized agents the permission to use, reuse, publish, and/or republish in whole or in part, in any medium (including the Simmons website, social media, and advertising) the photographs or video of me (individually or in a group in which I am included) that are taken during the photo or video shoot on this date, without restrictions as to changes or alterations, as they are used in conjunction with the representation and promotion of the University. I understand that all such recordings, in whatever medium, shall remain solely the property of Simmons University, and I shall have no right or interest in them.

If I am providing an image or images, rather than participating in a photoshoot, I confirm I am duly authorized to grant Simmons University and its authorized agents the permission to use, reuse, publish, and/or republish in whole or in part, in any medium (including the Simmons website, social media, and advertising) the photographs or video of me (individually or in a group in which I am included), without restrictions as to changes or alteration, as they are used in conjunction with the representation and promotion of the University. Any current copyrights or ownership of the image(s) remain unchanged.

2. I permit Simmons University and its authorized agents to use my image, name, and/or business title, as they are used in conjunction with the representation and promotion of the University.

3. I understand and acknowledge that I will NOT receive remuneration for the use of my name or image, as it is used in conjunction with the representation and promotion of the University.

4. I release Simmons University and those acting pursuant to its authority from liability or any violation of any personal or proprietary right I may have in connection with such use.

5. I am over 18 years of age and otherwise legally competent to sign this consent form. I have read this consent form in its entirety and understood it prior to executing it.
Formal Consent

Formal Consent Yes, I DO wish to participate No, I DO NOT wish to participate (for photoshoots, please inform the photographer or assistant)
Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

Image Consent Form

Image Consent Form

SUBJECT INFORMATION

AGREEMENT Terms of Agreement:

AGREEMENT

Terms of Agreement: