Photo and Video Release Form

Personal Information

First Name

Last Name

Phone

Consent

I consent to and authorize the use and reproduction by you — Goodwin University, Inc. — or anyone authorized by you, of my name, statements of information attributable to me, and my likeness, including any and all photographs and video which you have taken or will take of me, for any purpose related to Goodwin University, Inc. and the Goodwin Foundation, Inc., without further compensation to me. All photographs and video footage you have taken or will take of me, including photograph prints and video reproductions, shall constitute your property, solely and completely.

I have read and understand this Permission and Release Form.

Signature

DISCLAIMER: By typing your name in the signature field, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this form.

If you are human leave this field blank