Media Release Form

Download printable version

I hereby irrevocably grant to the Wayne Regional Educational Service Agency (Wayne RESA) the right to use photographs and videos containing my image, including audio recordings using the sound of my voice as recorded in audio or video recordings, without royalty, payment or other compensation to me (the “Materials”). I understand that the Materials may be used for educational, promotional and business purposes in diverse settings within an unrestricted geographic area. Wayne RESA is and shall be the exclusive owner of all rights in the Materials and I hereby irrevocably transfer, assign or otherwise convey to Wayne RESA any right, title, and interest that I may have in and to the Materials, including all copyrights and other intellectual property rights in the Materials.

Wayne RESA is a regional educational service agency that provides a variety of programs and services for nearly 20,000 PreK-12 teachers and more than 260,000 students in the 33 local school districts and 97 public school academies in Wayne County, Michigan.

By signing this release, I grant to Wayne RESA the absolute and irrevocable right to use, reuse, publish, and republish the photographs, videos and sound recordings, in whole or in part, individually or in connection with other material, in any and all media now or hereafter known, and for any purpose whatsoever, specifically including presentations, online courses, videos, digital and print advertising, promotional materials, websites, and social media without restriction as to alteration and without payment or cost of any value or kind. I waive the right to inspect or approve the finished product in which my image or likeness appears.

I release and discharge Wayne RESA from any and all claims and demands that may arise out of or in connection with the use of the photographs, videos and/or sound recordings, including without limitation, any and all claims for defamation, copyright infringement, violation of any right of publicity or privacy or violation of any other right arising out of this agreement.

Wayne RESA warrants that my image will not be used in a manner that could be considered libelous, obscene, or illegal. If I have questions, concerns, or require further information regarding this release, I understand that I may contact Wayne RESA at communications@resa.net or call (734) 334-1300.

By signing this release, I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby.

Wayne RESA Photo/Video Release Form

Student First Name

Student Last Name

Student School of Attendance (if applicable)

Street Address

City

State

Zip Code

Phone

Email Address

By selecting the “I agree” button, I am signing this document electronically. I agree that my electronic signature is the legal equivalent of my manual/handwritten signature on this document. By providing a telephone number and submitting this form you are consenting to be contacted by SMS text message. Message & data rates may apply. You can reply STOP to opt-out of further messaging.

I agree

Signature

Date

If the person signing this Release above is under the age of 18, then the signature of their parent or legal guardian is also required.

Parent/Guardian's Full Name

Parent/Guardian's Phone

Parent/Guardian's Email Address

By selecting the “I agree” button, I am signing this document electronically. I agree that my electronic signature is the legal equivalent of my manual/handwritten signature on this document.

I agree (parent/guardian)

Parent/Guardian's Signature

Date