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I hereby grant the photographer/videographer and Trustees of Boston University (“Boston University”), including its contractors, agents, assigns, and affiliates (such as its schools and departments, including the Boston University Fitness and Recreation Center), the worldwide, perpetual, irrevocable right to: (a) photograph, film, videotape, audio record, and otherwise record my name, image, likeness, and voice; and (b) copy, publish, distribute, display, create derivative works of, and otherwise use such materials in any media or format, for any purpose, without restriction.

I waive any right to inspect or approve the finished materials or their use, whether known or unknown to me at this time, and waive any rights to royalties or other compensation related to their use.

This release is unlimited in duration and geographic scope. It is governed by the laws of the Commonwealth of Massachusetts and constitutes the entire agreement between Boston University and me regarding these rights.

First Model Name
First Name*
Last Name*
First Model Age Acknowledgment*
First Model Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
Information
Street Address *
City *
State *
Zip *
First Model Signature*
Second Model Name
First Name*
Last Name*
Model Date of Birth*
Date of Birth
Information
Street Address *
City *
State *
Zip *
Third Model Name
First Name*
Last Name*
Model Date of Birth*
Date of Birth
Information
Street Address *
City *
State *
Zip *
Fourth Model Name
First Name*
Last Name*
Model Date of Birth*
Date of Birth
Information
Street Address *
City *
State *
Zip *
Fifth Model Name
First Name*
Last Name*
Model Date of Birth*
Date of Birth
Information
Street Address *
City *
State *
Zip *
Sixth Model Name
First Name*
Last Name*
Model Date of Birth*
Date of Birth
Information
Street Address *
City *
State *
Zip *
Seventh Model Name
First Name*
Last Name*
Model Date of Birth*
Date of Birth
Information
Street Address *
City *
State *
Zip *
Eighth Model Name
First Name*
Last Name*
Model Date of Birth*
Date of Birth
Information
Street Address *
City *
State *
Zip *
Ninth Model Name
First Name*
Last Name*
Model Date of Birth*
Date of Birth
Information
Street Address *
City *
State *
Zip *
Tenth Model Name
First Name*
Last Name*
Model Date of Birth*
Date of Birth
Information
Street Address *
City *
State *
Zip *
Parent or Guardian's Email Address
Email*
Confirm Email*

If the model is under 18, the undersigned parent or legal guardian consents to the foregoing on behalf of the minor and agrees to be bound by its terms.



By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
Information
Street Address *
City *
State *
Zip *
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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