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Photography/Video Request Form

Date of Request: September 21, 2023

First Requestor's Name

First Name*

Last Name*

Phone*
First Requestor's Date of Birth*
I certify that I am 18 years of age or older
First Requestor's Information

ID: *
Classification:*

If Other or Group please specify:

Name of Sponsor:

ID:
Please describe in detail what the photographs/videos will be used for:     
Personal
Academic
Marketing
Recruiting
Other
WILSON LOCATION (Check all that apply):
Lobby Area
Classroom 18
Classroom 20
Climbing Area
Weight Room
Wilson Basketball Courts (list below)
Card Basketball Courts (list below)
Racquetball Court
Taishoff Pool
Cardio Area
Combative Room
Multipurpose Rm 125
Multipurpose Rm 110
Upper Track Area
Functional Training Space
Other (list below)
BRODIE LOCATION (Check all that apply):
Lobby Area
Classroom
Cardio Area
Weight Room Area
Upper Basketball Courts (list below)
Lower Basketball Courts (list below)
Upper Track Area
Racquetball Court
Brodie Pool
Other (list below)

Equipment needs and/or equipment you would be bringing into facility: *
PROGRAM AREA - Include Specific Activity in Space Provided
Aquatics
Outdoor Adventure
Fitness and Wellness
Intramural Sports
Sports Clubs
Rentals
Physical Education
Open Recreation
Other

DATES OF PHOTOGRAPHY REQUESTED

MONDAY


Date(s):

Start time:

End time:

TUESDAY


Date(s):

Start time:

End time:

WEDNESDAY


Date(s):

Start time:

End time:

THURSDAY


Date(s):

Start time:

FRIDAY


Date(s):

Start time:

End time:

SATURDAY


Date(s):

Start time:

End time:

SUNDAY


Date(s):

Start time:

End time:

End time:
First Requestor's Signature*
Second Requestor's Name

First Name*

Last Name*
Second Requestor's Date of Birth*
Second Requestor's Information

ID: *
Classification:*

If Other or Group please specify:

Name of Sponsor:

ID:
Please describe in detail what the photographs/videos will be used for:     
Personal
Academic
Marketing
Recruiting
Other
WILSON LOCATION (Check all that apply):
Lobby Area
Classroom 18
Classroom 20
Climbing Area
Weight Room
Wilson Basketball Courts (list below)
Card Basketball Courts (list below)
Racquetball Court
Taishoff Pool
Cardio Area
Combative Room
Multipurpose Rm 125
Multipurpose Rm 110
Upper Track Area
Functional Training Space
Other (list below)
BRODIE LOCATION (Check all that apply):
Lobby Area
Classroom
Cardio Area
Weight Room Area
Upper Basketball Courts (list below)
Lower Basketball Courts (list below)
Upper Track Area
Racquetball Court
Brodie Pool
Other (list below)

Equipment needs and/or equipment you would be bringing into facility: *
PROGRAM AREA - Include Specific Activity in Space Provided
Aquatics
Outdoor Adventure
Fitness and Wellness
Intramural Sports
Sports Clubs
Rentals
Physical Education
Open Recreation
Other

DATES OF PHOTOGRAPHY REQUESTED

MONDAY


Date(s):

Start time:

End time:

TUESDAY


Date(s):

Start time:

End time:

WEDNESDAY


Date(s):

Start time:

End time:

THURSDAY


Date(s):

Start time:

FRIDAY


Date(s):

Start time:

End time:

SATURDAY


Date(s):

Start time:

End time:

SUNDAY


Date(s):

Start time:

End time:

End time:
Third Requestor's Name

First Name*

Last Name*
Third Requestor's Date of Birth*
Third Requestor's Information

ID: *
Classification:*

If Other or Group please specify:

Name of Sponsor:

ID:
Please describe in detail what the photographs/videos will be used for:     
Personal
Academic
Marketing
Recruiting
Other
WILSON LOCATION (Check all that apply):
Lobby Area
Classroom 18
Classroom 20
Climbing Area
Weight Room
Wilson Basketball Courts (list below)
Card Basketball Courts (list below)
Racquetball Court
Taishoff Pool
Cardio Area
Combative Room
Multipurpose Rm 125
Multipurpose Rm 110
Upper Track Area
Functional Training Space
Other (list below)
BRODIE LOCATION (Check all that apply):
Lobby Area
Classroom
Cardio Area
Weight Room Area
Upper Basketball Courts (list below)
Lower Basketball Courts (list below)
Upper Track Area
Racquetball Court
Brodie Pool
Other (list below)

Equipment needs and/or equipment you would be bringing into facility: *
PROGRAM AREA - Include Specific Activity in Space Provided
Aquatics
Outdoor Adventure
Fitness and Wellness
Intramural Sports
Sports Clubs
Rentals
Physical Education
Open Recreation
Other

DATES OF PHOTOGRAPHY REQUESTED

MONDAY


Date(s):

Start time:

End time:

TUESDAY


Date(s):

Start time:

End time:

WEDNESDAY


Date(s):

Start time:

End time:

THURSDAY


Date(s):

Start time:

FRIDAY


Date(s):

Start time:

End time:

SATURDAY


Date(s):

Start time:

End time:

SUNDAY


Date(s):

Start time:

End time:

End time:
Fourth Requestor's Name

First Name*

Last Name*
Fourth Requestor's Date of Birth*
Fourth Requestor's Information

ID: *
Classification:*

If Other or Group please specify:

Name of Sponsor:

ID:
Please describe in detail what the photographs/videos will be used for:     
Personal
Academic
Marketing
Recruiting
Other
WILSON LOCATION (Check all that apply):
Lobby Area
Classroom 18
Classroom 20
Climbing Area
Weight Room
Wilson Basketball Courts (list below)
Card Basketball Courts (list below)
Racquetball Court
Taishoff Pool
Cardio Area
Combative Room
Multipurpose Rm 125
Multipurpose Rm 110
Upper Track Area
Functional Training Space
Other (list below)
BRODIE LOCATION (Check all that apply):
Lobby Area
Classroom
Cardio Area
Weight Room Area
Upper Basketball Courts (list below)
Lower Basketball Courts (list below)
Upper Track Area
Racquetball Court
Brodie Pool
Other (list below)

Equipment needs and/or equipment you would be bringing into facility: *
PROGRAM AREA - Include Specific Activity in Space Provided
Aquatics
Outdoor Adventure
Fitness and Wellness
Intramural Sports
Sports Clubs
Rentals
Physical Education
Open Recreation
Other

DATES OF PHOTOGRAPHY REQUESTED

MONDAY


Date(s):

Start time:

End time:

TUESDAY


Date(s):

Start time:

End time:

WEDNESDAY


Date(s):

Start time:

End time:

THURSDAY


Date(s):

Start time:

FRIDAY


Date(s):

Start time:

End time:

SATURDAY


Date(s):

Start time:

End time:

SUNDAY


Date(s):

Start time:

End time:

End time:
Fifth Requestor's Name

First Name*

Last Name*
Fifth Requestor's Date of Birth*
Fifth Requestor's Information

ID: *
Classification:*

If Other or Group please specify:

Name of Sponsor:

ID:
Please describe in detail what the photographs/videos will be used for:     
Personal
Academic
Marketing
Recruiting
Other
WILSON LOCATION (Check all that apply):
Lobby Area
Classroom 18
Classroom 20
Climbing Area
Weight Room
Wilson Basketball Courts (list below)
Card Basketball Courts (list below)
Racquetball Court
Taishoff Pool
Cardio Area
Combative Room
Multipurpose Rm 125
Multipurpose Rm 110
Upper Track Area
Functional Training Space
Other (list below)
BRODIE LOCATION (Check all that apply):
Lobby Area
Classroom
Cardio Area
Weight Room Area
Upper Basketball Courts (list below)
Lower Basketball Courts (list below)
Upper Track Area
Racquetball Court
Brodie Pool
Other (list below)

Equipment needs and/or equipment you would be bringing into facility: *
PROGRAM AREA - Include Specific Activity in Space Provided
Aquatics
Outdoor Adventure
Fitness and Wellness
Intramural Sports
Sports Clubs
Rentals
Physical Education
Open Recreation
Other

DATES OF PHOTOGRAPHY REQUESTED

MONDAY


Date(s):

Start time:

End time:

TUESDAY


Date(s):

Start time:

End time:

WEDNESDAY


Date(s):

Start time:

End time:

THURSDAY


Date(s):

Start time:

FRIDAY


Date(s):

Start time:

End time:

SATURDAY


Date(s):

Start time:

End time:

SUNDAY


Date(s):

Start time:

End time:

End time:
Sixth Requestor's Name

First Name*

Last Name*
Sixth Requestor's Date of Birth*
Sixth Requestor's Information

ID: *
Classification:*

If Other or Group please specify:

Name of Sponsor:

ID:
Please describe in detail what the photographs/videos will be used for:     
Personal
Academic
Marketing
Recruiting
Other
WILSON LOCATION (Check all that apply):
Lobby Area
Classroom 18
Classroom 20
Climbing Area
Weight Room
Wilson Basketball Courts (list below)
Card Basketball Courts (list below)
Racquetball Court
Taishoff Pool
Cardio Area
Combative Room
Multipurpose Rm 125
Multipurpose Rm 110
Upper Track Area
Functional Training Space
Other (list below)
BRODIE LOCATION (Check all that apply):
Lobby Area
Classroom
Cardio Area
Weight Room Area
Upper Basketball Courts (list below)
Lower Basketball Courts (list below)
Upper Track Area
Racquetball Court
Brodie Pool
Other (list below)

Equipment needs and/or equipment you would be bringing into facility: *
PROGRAM AREA - Include Specific Activity in Space Provided
Aquatics
Outdoor Adventure
Fitness and Wellness
Intramural Sports
Sports Clubs
Rentals
Physical Education
Open Recreation
Other

DATES OF PHOTOGRAPHY REQUESTED

MONDAY


Date(s):

Start time:

End time:

TUESDAY


Date(s):

Start time:

End time:

WEDNESDAY


Date(s):

Start time:

End time:

THURSDAY


Date(s):

Start time:

FRIDAY


Date(s):

Start time:

End time:

SATURDAY


Date(s):

Start time:

End time:

SUNDAY


Date(s):

Start time:

End time:

End time:
Seventh Requestor's Name

First Name*

Last Name*
Seventh Requestor's Date of Birth*
Seventh Requestor's Information

ID: *
Classification:*

If Other or Group please specify:

Name of Sponsor:

ID:
Please describe in detail what the photographs/videos will be used for:     
Personal
Academic
Marketing
Recruiting
Other
WILSON LOCATION (Check all that apply):
Lobby Area
Classroom 18
Classroom 20
Climbing Area
Weight Room
Wilson Basketball Courts (list below)
Card Basketball Courts (list below)
Racquetball Court
Taishoff Pool
Cardio Area
Combative Room
Multipurpose Rm 125
Multipurpose Rm 110
Upper Track Area
Functional Training Space
Other (list below)
BRODIE LOCATION (Check all that apply):
Lobby Area
Classroom
Cardio Area
Weight Room Area
Upper Basketball Courts (list below)
Lower Basketball Courts (list below)
Upper Track Area
Racquetball Court
Brodie Pool
Other (list below)

Equipment needs and/or equipment you would be bringing into facility: *
PROGRAM AREA - Include Specific Activity in Space Provided
Aquatics
Outdoor Adventure
Fitness and Wellness
Intramural Sports
Sports Clubs
Rentals
Physical Education
Open Recreation
Other

DATES OF PHOTOGRAPHY REQUESTED

MONDAY


Date(s):

Start time:

End time:

TUESDAY


Date(s):

Start time:

End time:

WEDNESDAY


Date(s):

Start time:

End time:

THURSDAY


Date(s):

Start time:

FRIDAY


Date(s):

Start time:

End time:

SATURDAY


Date(s):

Start time:

End time:

SUNDAY


Date(s):

Start time:

End time:

End time:
Eighth Requestor's Name

First Name*

Last Name*
Eighth Requestor's Date of Birth*
Eighth Requestor's Information

ID: *
Classification:*

If Other or Group please specify:

Name of Sponsor:

ID:
Please describe in detail what the photographs/videos will be used for:     
Personal
Academic
Marketing
Recruiting
Other
WILSON LOCATION (Check all that apply):
Lobby Area
Classroom 18
Classroom 20
Climbing Area
Weight Room
Wilson Basketball Courts (list below)
Card Basketball Courts (list below)
Racquetball Court
Taishoff Pool
Cardio Area
Combative Room
Multipurpose Rm 125
Multipurpose Rm 110
Upper Track Area
Functional Training Space
Other (list below)
BRODIE LOCATION (Check all that apply):
Lobby Area
Classroom
Cardio Area
Weight Room Area
Upper Basketball Courts (list below)
Lower Basketball Courts (list below)
Upper Track Area
Racquetball Court
Brodie Pool
Other (list below)

Equipment needs and/or equipment you would be bringing into facility: *
PROGRAM AREA - Include Specific Activity in Space Provided
Aquatics
Outdoor Adventure
Fitness and Wellness
Intramural Sports
Sports Clubs
Rentals
Physical Education
Open Recreation
Other

DATES OF PHOTOGRAPHY REQUESTED

MONDAY


Date(s):

Start time:

End time:

TUESDAY


Date(s):

Start time:

End time:

WEDNESDAY


Date(s):

Start time:

End time:

THURSDAY


Date(s):

Start time:

FRIDAY


Date(s):

Start time:

End time:

SATURDAY


Date(s):

Start time:

End time:

SUNDAY


Date(s):

Start time:

End time:

End time:
Ninth Requestor's Name

First Name*

Last Name*
Ninth Requestor's Date of Birth*
Ninth Requestor's Information

ID: *
Classification:*

If Other or Group please specify:

Name of Sponsor:

ID:
Please describe in detail what the photographs/videos will be used for:     
Personal
Academic
Marketing
Recruiting
Other
WILSON LOCATION (Check all that apply):
Lobby Area
Classroom 18
Classroom 20
Climbing Area
Weight Room
Wilson Basketball Courts (list below)
Card Basketball Courts (list below)
Racquetball Court
Taishoff Pool
Cardio Area
Combative Room
Multipurpose Rm 125
Multipurpose Rm 110
Upper Track Area
Functional Training Space
Other (list below)
BRODIE LOCATION (Check all that apply):
Lobby Area
Classroom
Cardio Area
Weight Room Area
Upper Basketball Courts (list below)
Lower Basketball Courts (list below)
Upper Track Area
Racquetball Court
Brodie Pool
Other (list below)

Equipment needs and/or equipment you would be bringing into facility: *
PROGRAM AREA - Include Specific Activity in Space Provided
Aquatics
Outdoor Adventure
Fitness and Wellness
Intramural Sports
Sports Clubs
Rentals
Physical Education
Open Recreation
Other

DATES OF PHOTOGRAPHY REQUESTED

MONDAY


Date(s):

Start time:

End time:

TUESDAY


Date(s):

Start time:

End time:

WEDNESDAY


Date(s):

Start time:

End time:

THURSDAY


Date(s):

Start time:

FRIDAY


Date(s):

Start time:

End time:

SATURDAY


Date(s):

Start time:

End time:

SUNDAY


Date(s):

Start time:

End time:

End time:
Tenth Requestor's Name

First Name*

Last Name*
Tenth Requestor's Date of Birth*
Tenth Requestor's Information

ID: *
Classification:*

If Other or Group please specify:

Name of Sponsor:

ID:
Please describe in detail what the photographs/videos will be used for:     
Personal
Academic
Marketing
Recruiting
Other
WILSON LOCATION (Check all that apply):
Lobby Area
Classroom 18
Classroom 20
Climbing Area
Weight Room
Wilson Basketball Courts (list below)
Card Basketball Courts (list below)
Racquetball Court
Taishoff Pool
Cardio Area
Combative Room
Multipurpose Rm 125
Multipurpose Rm 110
Upper Track Area
Functional Training Space
Other (list below)
BRODIE LOCATION (Check all that apply):
Lobby Area
Classroom
Cardio Area
Weight Room Area
Upper Basketball Courts (list below)
Lower Basketball Courts (list below)
Upper Track Area
Racquetball Court
Brodie Pool
Other (list below)

Equipment needs and/or equipment you would be bringing into facility: *
PROGRAM AREA - Include Specific Activity in Space Provided
Aquatics
Outdoor Adventure
Fitness and Wellness
Intramural Sports
Sports Clubs
Rentals
Physical Education
Open Recreation
Other

DATES OF PHOTOGRAPHY REQUESTED

MONDAY


Date(s):

Start time:

End time:

TUESDAY


Date(s):

Start time:

End time:

WEDNESDAY


Date(s):

Start time:

End time:

THURSDAY


Date(s):

Start time:

FRIDAY


Date(s):

Start time:

End time:

SATURDAY


Date(s):

Start time:

End time:

SUNDAY


Date(s):

Start time:

End time:

End time:
Requestor's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


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*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

ID: *
Classification:*

If Other or Group please specify:

Name of Sponsor:

ID:
Please describe in detail what the photographs/videos will be used for:     
Personal
Academic
Marketing
Recruiting
Other
WILSON LOCATION (Check all that apply):
Lobby Area
Classroom 18
Classroom 20
Climbing Area
Weight Room
Wilson Basketball Courts (list below)
Card Basketball Courts (list below)
Racquetball Court
Taishoff Pool
Cardio Area
Combative Room
Multipurpose Rm 125
Multipurpose Rm 110
Upper Track Area
Functional Training Space
Other (list below)
BRODIE LOCATION (Check all that apply):
Lobby Area
Classroom
Cardio Area
Weight Room Area
Upper Basketball Courts (list below)
Lower Basketball Courts (list below)
Upper Track Area
Racquetball Court
Brodie Pool
Other (list below)

Equipment needs and/or equipment you would be bringing into facility: *
PROGRAM AREA - Include Specific Activity in Space Provided
Aquatics
Outdoor Adventure
Fitness and Wellness
Intramural Sports
Sports Clubs
Rentals
Physical Education
Open Recreation
Other

DATES OF PHOTOGRAPHY REQUESTED

MONDAY


Date(s):

Start time:

End time:

TUESDAY


Date(s):

Start time:

End time:

WEDNESDAY


Date(s):

Start time:

End time:

THURSDAY


Date(s):

Start time:

FRIDAY


Date(s):

Start time:

End time:

SATURDAY


Date(s):

Start time:

End time:

SUNDAY


Date(s):

Start time:

End time:

End time:
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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