Student Media Access Waiver

This waiver grants permission for student participation in media-related activities and use of related images, videos, or audio by the institution or its affiliates. Please complete all applicable sections.

Student Information

Full Name Student ID School/Department Contact Email/Phone

Media Access Waiver

I, the undersigned, hereby authorize the institution to record, use, and share photographs, video, or audio recordings in which I appear for educational, promotional, or publicity purposes in print, online, or other media.

List any limitations or restrictions (if any):

Student Signature

Date

Parent/Guardian Consent (if student is under 18)

Parent/Guardian Name

Parent/Guardian Signature

Date