Photo and Video Authorization, Agreement and Liability Release Form

This subject-party release form (the agreement) is crafted for the purpose of authorizing and
releasing from liability the Eta Theta Lambda Chapter and the Education Foundation upon using
photos and videos to promote organizational programs and is hereby entered into


Eta Theta Lambda Chapter of (Alpha Phi Alpha Fraternity, Inc.) and the Eta Theta Lambda
Education Foundation PO Box 501, West Hempstead, NY 11552 (the photographer/videographer)


College Tour participant

A.  The photographer/videographer  (Eta Theta Lambda/Education Foundation) may elect from
time to time to engage in the business of creative media, which includes but is not limited to
engaging in the following activities for organizational and potential commercial/programmatic gain:  
filming, film-video editing, and film/video production; photography, photo editing and photo
production; digital photography, digital photo editing and digital photo production; documentary
production and editing; play/script writing and stage productions; sound recordings; sound
manipulation and music productions; television production; web design and production; and writing
(e.g., brochures and ads).

B.  The subject-party consents to being a subject of the photographer/videographer in various
media/forms.  The subject-party will allow the photographer/videographer to capture images and
sound recordings for use in various media.

The photographer/videographer (Eta Theta Lambda Chapter/Education Foundation) IS RELEASED
OF LIABILITY for good and valuable consideration herein acknowledged as received; subject-party
releases the photographer/videographer and assigns permission to license all images and sound
recordings and to use images and sound recordings in any media for any legitimate and reputable
purpose which may include advertising, promotion, marketing and packaging for any legal and
ethical product or service.  The subject-party agrees that any images and sound recordings may be
combined with other images, text and graphics and may be cropped, altered and modified.  The
subject-party agrees that the photographer/videographer has no legal duty to show the subject-
party any material prior to using or distributing work products/materials in any legitimate and
reputable form.
Student Participant Name
Home Address
Parent Signature (please type in full name and check the box to the right).