Release Form Template

This is a sample template release form that could be adapted to specific departmental needs.

Release and Clearance

Program Name:

Project Number:

I, _____________________________________, enter into this Release with the University of Washington and _________________. I authorize the University to create recordings of my image, likeness, and/or voice (“Recordings”) in connection with my presentation at the Event. I agree the Recordings may take the form of photographs, films, video and audio tapes, CD-ROMs, DVDs, digital files, and/or any other media. The University, at its discretion, may use and allow others to use the Recordings in their original or edited form in any media for any and all educational and commercial purposes, and may use and allow others to use my name, image, likeness, voice, and biographical or other information in connection with the Recordings. I understand that use of the Recordings may include, but not necessarily be limited to, the following:

• Internal use at the University of Washington and other institutions
• Streaming in digital format (live or on demand) on the Internet

To the best of my knowledge, all materials I will use in my presentation are my own or are materials for which I have obtained any necessary permission. If I am using materials to which I do not own the copyright, I understand that some uses of the Recordings, such as broadcast or streaming uses, may require permission from the copyright holder even though such permission would not be required for traditional classroom use. My presentation will not infringe any copyrights or other rights of others, and will contain nothing defamatory or obscene. My presentation and materials used are not subject to any prior agreements that would limit the scope of the permission I am granting here. If I breach the representations I am making here, and if the University should suffer damages as a result, I agree to indemnify the University for those damages.

I further acknowledge that I will not be compensated for any uses made of the Recordings, and that the University exclusively owns all rights to these Recordings. However, except for the permissions I am granting here, I retain all rights I may otherwise hold in copyrighted materials included in my presentation and/or incorporated into the Recordings.

I hereby release the University from all Claims relating to the use of the Recordings. For this purpose, a "Claim" is any legal proceeding, such as a suit for defamation, invasion of privacy, or infringement of copyright. In addition, my release of the University includes both the University itself and the University's officials, employees, representatives, agents, licensees, successors, and assigns.

I have read and understood the contents of this Release, and I have the right and authority to execute it.

Releaser's Signature _______________________   Date ______________________