UAB Media Release Form

Information



Standard Media Release
AUTHORIZATION AND RELEASE

The University of Alabama at Birmingham (hereinafter “UAB”) produces informative materials in various media formats for use as educational materials for the general public in the areas of research, patient care, and other areas of interest.

To accomplish this important goal of UAB, UAB requests persons to authorize it to utilize their name, likeness, voice, and/or performance, whether by motion picture, photograph, or quoted statements.

In the interest of furthering the above purpose, I knowingly and willingly agree to be bound by this authorization and release by submitting this form and agrees as follows:
  • To authorize UAB to record my name, likeness, voice, and/or performance by any means of recording, in particular, but without limitation, photograph, motion picture, and/or videotape; and
  • To authorize UAB to use my name, likeness, voice, and/or performance in any means of print and/or digital or Web publication, distribution, or electronic broadcast including, without limitation, social media, websites, magazines, media stories, etc.; and
  • To not receive any form of consideration, in particular, but without limitation, royalties and/or payments from UAB or related entities, for said recording and use by UAB of my name, likeness, voice, and/or performance in any means of publication; and
  • UAB has all rights, title, and interest to and the undersigned hereby assigns to UAB any rights of the undersigned to any recording and any use of the recordation made pursuant to this authorization; further, UAB is authorized to control distribution, editing, and use of the said recording locally, nationally, and internationally; and
  • To release and hold harmless UAB, UAB-related entities, and their agents, personnel, trustees, directors, officers, and employees against any and all claims for loss, damages, or injuries as a result of participating in the activities anticipated by this Agreement, in particular, but without limitation, the publication and the recording of the name, likeness, voice, and/or performance of the undersigned.
Parent/Guardian Authorization for Minor


If the person providing this Authorization and Release is under the age of 18, a Parent/Guardian must complete this document on behalf of this person.  The Parent/Guardian certifies that they are over the age of 18, have read, considered, and understand this document, have the legal right to act and sign on behalf of the person giving the Authorization and Release, are providing this this Authorization and Release voluntarily, acknowledge that no oral representations, statements, or inducements have been made separate and apart from the terms of this Authorization and Release, and agree to enter into the same, fully intending to legally bind the person giving this Authorization and Release identified herein as well as their heirs, successors, and assigns to the terms of this Authorization and Release.

Student Media Release
AUTHORIZATION AND RELEASE

The University of Alabama at Birmingham (hereinafter “UAB”) produces informative materials in various media formats for use by students, patients, faculty, staff, medical researchers and the general public.  To accomplish this important goal of UAB, UAB requests persons to authorize it to use their name, likeness, voice, and/or performance, including without limitation, in quoted statements, photographs and audio and video recordings.

I hereby grant my permission and consent to UAB and its affiliated entities and their trustees, directors, officers, agents, representatives, and employees (collectively, “UAB Representatives”) to photograph, video record, and audio record my name, image, likeness, voice and/or performance (“Image”) and use my quoted statements. I grant my permission and consent for UAB, its affiliated entities and UAB Representatives to publish and display photographs, video recordings, and/or audio recordings  (collectively “Media”) containing my Image, which includes my voice, and quoted statements, when that Media has been taken

(a) at a university event that is open to the general public (e.g. athletic game or competition, homecoming parade, commencement);

(b) at a university event sponsored for students, faculty, staff or community members (e.g. welcome ceremony for a school or department, student life event, resident hall events, concerts or similar student experience programing, awards ceremony or reception); 

(c) at an event sponsored by a student organization recognized by the university (e.g. student club activity or event); 

(d) during an academic activity (e.g. class, lab, internship); or 

(e) in the University Relations photography studio (e.g. “head shot”, press release photo or university publication photo) (“UAB Media”).  

I grant my permission and consent for UAB, its affiliated entities and UAB Representatives to publish and display UAB Media containing my Image and quoted statements in official UAB and UAB affiliated entity publications and materials (e.g. articles, brochures, books, magazines, newsletters, tickets, advertisements and training materials) or on or in official UAB and UAB affiliated entity social media sites, websites, films and videos hosted or maintained by, on behalf of, or for the benefit of, UAB and its affiliated entities (“UAB Materials”) for promotional, educational, informational, fund-raising, advertising or commercial purposes.  

I hereby grant an irrevocable, world-wide, royalty-free right and license to UAB, its affiliated entities and UAB Representatives to publish and display UAB Media containing my Image in UAB Materials for promotional, educational, informational, fund-raising, advertising or commercial purposes.  Furthermore, I hereby authorize and consent to the use of my Image in the UAB Media for the UAB Materials or any other purposes deemed appropriate by UAB. I understand and agree that UAB is and shall be the exclusive owner of all right, title, and interest, including any copyright, in the UAB Media and UAB Materials.  I understand and agree that UAB may distribute, disclose, and display the UAB Media containing my Image and quoted statements to the general public for the purposes set forth above.

I authorize UAB, its affiliated entities, and UAB Representatives to disclose and share UAB Media containing my Image and quoted statements to third-party media organizations and outlets for promotional, educational, communications, informational, fund-raising, advertising and commercial purposes.

I hereby waive any right to be notified or to inspect or approve the UAB Media or UAB Materials that contain my Image and quoted statements, now or in the future, whether that use is known or unknown to me. I hereby waive any right to royalties or other compensation arising from or related to the use or disclosure of the UAB Media or UAB Materials. I hereby release and hereby agree to indemnify and hold harmless UAB, its affiliated entities, and UAB Representatives and their licensees and assigns for any and all claims that I or any third party may have now or in the future for invasion of privacy, right of publicity, copyright infringement, defamation, or any other cause of action arising of the use, utilization, adaptation, modification, reproduction, distribution, public performance, disclosure or display of my Image and quoted statements in the UAB Media and UAB Materials and disclosure of UAB Media to third-party media outlets and organizations. In accordance with this complete release of all rights in my Image and quoted statements used in the UAB Media and UAB Materials, I hereby waive any and all claims, damages, or liability arising from or related to the use of the UAB Media or UAB Materials. 

I have read and voluntarily submit this form as authorization and release of liability and agree to be bound by the terms and conditions herein.  I understand that by submitting this authorization and release I waive my privacy rights under the Family Educational Rights and Privacy Act (FERPA) and other privacy rights provided by law.
Parent/Guardian Authorization for Minor


If the person providing this Authorization and Release is under the age of 18, a Parent/Guardian must complete this document on behalf of this person.  The Parent/Guardian certifies that they are over the age of 18, have read, considered, and understand this document, have the legal right to act and sign on behalf of the person giving the Authorization and Release, are providing this this Authorization and Release voluntarily, acknowledge that no oral representations, statements, or inducements have been made separate and apart from the terms of this Authorization and Release, and agree to enter into the same, fully intending to legally bind the person giving this Authorization and Release identified herein as well as their heirs, successors, and assigns to the terms of this Authorization and Release.

UAB Media Release
We already have a UAB Media Release on file for you. No further action is needed at this time.



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Authorization Form Consent