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Consent and Photo/Video Release Form

I the undersigned hereby agree to accept all conditions set forth in this consent and release.

I hereby give the Massachusetts Department of Elementary and Secondary Education permission to post to its websites, and /or assign specific permission to: copyright, publish, distribute and/or display photographic images and/or video produced by me.

The undersigned, hereby releases and discharges the Massachusetts Department of Elementary and Secondary Education, and/or assigns from any and all liability by virtue of distortion, blurring, alteration, optical illusion and/or use in composite form, whether the same is intentional, or otherwise. S/he understands that images/video posted on the internet can be viewed and downloaded by others. S/he understands that Department of Elementary and Secondary Education staff may use any process or procedure resulting in the completion of the finished product, the publication, distribution, or public display.

Usage: To display images on website and/or for the use of images and/or video in publications, media, and print collateral.

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By signing this consent and release form, the undersigned certifies that before signing this document that s/he has read it completely and understand its meaning. The undersigned hereby releases and gives up any and all future claims and rights, which s/he may have at any time, as long as the images are used in accordance to the usage above by the Massachusetts Department of Elementary and Secondary Education.

Signature:
___________________________________
Name:
(print):
___________________________________
Date:
___________________________________
Address:
___________________________________


Last Updated: September 17, 2014
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