Filming, Photographic and Sound Recording Release Form

I hereby give dom judson the right to use (delete as appropriate)

video recording(s)
sound recording(s)
photograph(s)
of myself.
Taken on/between: 29th February 2015
for use in: .media
or in any other productions where Priestley Sixth Form College may wish to use the
material(s) for
marketing and publicity or any other use in electronic, web or paper based forms.
I understand that the material will be used solely for the promotion or benefit of the
college and that it
may be released for use by external media organisations in accordance with this
purpose.
I understand the material(s) will be the copyright of Priestley College and may be
used as is or in conjunction with other material(s), as part of a composite
production.
I understand that I have the right to ask the College to stop using my image or
photograph(s) in any future publications. However, I acknowledge that the College
cannot recall publications in which my image has already appeared.
Signed
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Print Name
Luke dickinson
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Date
29/1/15
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Address
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Email:

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The personal information provided on this form will be used for the purpose of
administering the use of your images/recordings at the College only and will be
processed in accordance with the Data Protection Act 1998.