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Risk Mgmt - Use of Image Consent and Release - Minors
Risk Mgmt - Use of Image Consent and Release - Minors
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Parents or guardians can complete this form to allow their child/dependent to be photographed during a Duquesne University Minors Program.
Title
A short description to explain the nature of a ticket.
Use of Image Consent and Release - Minors
Name of Duquesne University Minors Program
Program Start Date
(mm/dd/yyyy)
Name of Duquesne University Student/Employee serving as Program Coordinator
Email Address of Duquesne University Student/Employee serving as Program Coordinator
Participant Full Name
Age of Minor Participant
I hereby give to Duquesne University of the Holy Spirit (Duquesne), along with its agents, employees, legal representatives, and assigns the right and license to use my child's/dependent's name, image, likeness, and comments in Duquesne materials for internal and external audiences. These materials include, but are not limited to advertisements, brochures, viewbooks, news releases, magazines, newspapers, newsletters, videos, websites, and social media. Participant’s images may be used in all marketing, including university-wide communication for all audiences and across all Duquesne schools and programs. It is hereby stipulated and agreed that such production and use will not violate my child’s/dependent's rights, and I, for myself, my heirs, executors, administrators, and assigns, hereby release and discharge Duquesne and its agents and employees from any and all claims, demands, and/or causes of action of whatever kind, for its actions taken pursuant to the authority granted herein. Further, it is hereby stipulated and agreed that I will receive no compensation for the use of my child's/dependent name, likeness, or comments, and Duquesne University will incur no liability for payment of compensation to me nor any person or organization as a result of its production and use thereof.
Name of Parent/Guardian
Parent/Guardian E-mail
Parent/Guardian Phone Number
I HAVE READ THE ABOVE RELEASE AND HOLD HARMLESS AGREEMENT, I UNDERSTAND THE SAME, AND I AGREE TO BE LEGALLY BOUND BY ALL OF THE TERMS STATED THEREIN.*
Agreement
Agreement (required)
I have read the above release and agree to the hold harmless agreement.
Other Fields
Your name
Your first name
Your last name
Your email address
Verification Code