Oakland Community College

Student Request Forms

Photographic/Publicity Release

Name: _________________________________ Date: ______________________

With the intention to gift the College, I hereby authorize Oakland Community College, its agents and employees, and any person, firm or organization that the College may designate or authorize, to use information and photographs or motion pictures with or without my name and biographical data concerning me, without limitation as to time and frequency of use, modified or retouched, for any and all of the following purposes when used in conjunction with the production and release of information about Oakland Community College activities: (Strike out and initial any of the purposes not desired and authorized)

1. New release (including print, television or radio)
2. Release to other media
3. Educational, instructional or teaching purposes
4. Fund raising, advertising and publicity releases

I also hereby waive and forego any right, entitlement or claim I might have to any compensation, fees, or benefits by reason of any appearance on, or publication, in any communications media in accordance with the above. I specifically may designate or authorize, from any liability or other obligation arising out of the use of such information as I have herein authorized or from the use of any material furnished by me in conjunction therewith.

Signature: _____________________________________

Parent or guardian signature (required if a minor): ____________________________________