Homepage

Photo Release Form for Minors - Authorization and Release

The Graduate Center of The City University of New York produces and releases a variety of print and electronic images and recordings, including posters, brochures, photographs, online materials, videotapes and electronic media files.

This form is for participants under the age of 18. A parent or legal guardian must complete and sign this form on the participant's behalf. Participants 18 or older should use the standard Photo Release Form.

Participant

First Name*

Last Name*

Participant is under 18*

Parent or Guardian

First Name*

Last Name*

Relationship to Participant*

Email*

Phone*

Address - Line 1*

Address - Line 2

Parent of Guardian's Typed Signature*

I am the parent or legal guardian of the participant above and I hereby grant to the University nonexclusive permission to reproduce for educational or promotional purposes in any media forum, in whole or in part, photographs, videotapes and other media materials which may include the participant’s picture, image or voice. Agree