Photo Release Form

This Photo Release is given on the date set forth below to the University of Central Arkansas (“UCA”).

For purposes of this Agreement, the term “UCA” shall refer to and mean the University of Central Arkansas, the President of UCA, any past, present and future members of the UCA Board of Trustees, any employee, representative or agent of UCA, and any entity associated with, or controlled by, UCA.

I hereby grant permission to UCA the right to reproduce, use, exhibit, display, broadcast, distribute, and create derivative works of photographs or videos containing the image/likeness of me or my child named below. I understand these images and other personally identifiable information may be used for promotional, news, research, and educational purposes.

For myself, my child and other children, and all of my heirs, personal representatives, successors and assigns, or any other persons claiming by or through me, I do hereby forever waive, release and relinquish any and all claims, demands, causes of action, liabilities, costs or expenses (including, but not limited to, attorneys’ fees) (all of the foregoing being referred to collectively as “Claims”), against UCA which are associated with, or arise out of or in any manner are related to, anything contained in the photographs or videos. The waiver and release set forth herein waives and releases any and all Claims under any federal or state law, as well as any common law cause of action, whether in contract, tort or any other legal theory.

A photocopy of this document shall be deemed to be an original. Before I signed this document, I was given the opportunity to read it. I have signed this document freely and voluntarily on the date set forth below. I certify that I am at least 18 years of age.