Latin Form D – Student Release Form for Use of Photograph, Image, Voice, Performances and Appearances

This form is due no later than [date]. Note: There are [insert number] sections. REMINDER: Please also send a check (NO CASH) for $75 for the student activity fee, payable to Washington and Lee University with the student’s name and designated Academy (Spanish 2027, French 2027, or German 2027, Japanese 2027, Latin 2027) on the memo line mailed to the University at this address: Virginia Governor’s Language Academy Washington and Lee University 204 W Washington St Lexington, VA, 24450

During this session of the Governor’s World Language Academies, many photographs and videos of students will be made during their activities. Many of these pictures will be included on the Academy memory flash drive. Some photos and videos could appear on the Governor’s World Language Academy Web site posted by the Virginia Department of Education or on materials or Websites prepared by Washington and Lee University. Students will also be asked to evaluate and comment on the program, and some of their quotes may be used as well. For security reasons, only the first names of students or no names will be used in the description of these photos and videos, or in identifying the quotes. I, the undersigned, hereby grant permission to the Virginia Department of Education (hereinafter Department) and/or Washington and Lee University (hereinafter WLU), and their employees, agents, assigns and licensees to photograph my child and to record my child’s image, voice, performances and appearances. I hereby grant permission to the Department and/or WLU and their employees, agents, assigns and licensees to use my child’s name, picture, photograph, image or other reproductions of my child’s physical likeness, voice and recording for any and all purposes within the scope of the Department’s role in public education and government without notifying me in advance. I waive any right to inspect or approve the finished picture, photograph, image or other reproductions of my child’s physical likeness, voice and recording or any printed or electronic matter that may be used with them or to be compensated for them. The Department and/or WLU and their employees, agents, assigns and licensees may use only my child’s first name, picture, photograph, image or other reproductions of my child’s physical likeness and voice for any and all purposes in any medium or format, including but not limited to in videotape, audiotape, film, photograph, television, radio, digital, Internet, intranet, theater or exhibition. In doing so, I agree to the unlimited distribution, promotion and exhibition of the first name, picture, photograph, image or other reproductions of my child’s physical likeness, voice and recording. I agree that I waive and therefore I shall not assert or maintain against the Department and/or WLU and their employees, agents, assigns and licensees any claim, action, suit or demand of any kind or nature whatsoever, including but not limited to, those claims grounded upon invasion of privacy, rights of publicity or other civil rights or for any reason in connection with the Department’s and/or WLU’s and their agents, assigns and licensees authorized use of my child’s name picture, photograph, image or other reproductions of my child’s physical likeness, voice and recording. I agree that the Virginia Department of Education owns the pictures, photographs, images or other reproductions of my child’s physical likeness, voice and recording created pursuant to this release and all rights related to them. I agree to release, indemnify and hold harmless the Commonwealth of Virginia, the Virginia Department of Education, and WLU, and their respective employees, agents, assigns and licensees from liability against any claims or damages arising from or related to the use of my child’s first name, picture, photograph, image or other reproductions of my child’s physical likeness, voice and recording including but not limited to any misuse or distortion by third parties.