Photograph and Personal Data Release Form

Recording and Personal Data Authorization and Release Form
I have elected to participate in
, being held at Illinois Institute of Technology’s (“IIT”)
, Chicago, IL, on
(the “Event”).
I hereby grant to “IIT” the perpetual, royalty-free, world-wide right, permission and license to
make, take, use, copy, edit, reproduce, and/or distribute, including, without limitation, via its
World Wide Website as well as its designated webpage on Facebook and YouTube as well as
other websites of its choosing, in IIT publications and in connection with IIT publicity and media
materials and efforts, any photographic/digital/videotaped images and recordings of me
and/or my voice taken at the Event and to use my name and city of residence in connection
the same (collectively, the “Images and Recordings”), all without further consideration. I
acknowledge IIT's right to edit, crop and treat the Images and Recordings at its discretion. I
acknowledge that IIT may choose not to use the Images and Recordings at this time, but may do
so, at its discretion, at a later date. I understand that once the Images and Recordings are posted
on IIT’s website or otherwise posted on the Internet or used, the Images and Recordings are
subject to being downloaded by any computer user anywhere. IIT reserves the right to
discontinue use of the Images and Recordings without notice.
I confirm that my consent to the foregoing undertakings, uses and disclosures is being made
knowingly and voluntarily, and I state and acknowledge that I am freely and knowingly agreeing
to accept and to assume any and all risks that may arise from or be related to such undertakings,
uses and disclosures. Further, as this grant is being freely and knowingly given, I agree, represent
and warrant that (i) I shall not attempt to hold IIT and/or its trustees, officers, employees, faculty,
agents, and volunteers liable for any kind of injury, death, damage or loss to person or property
resulting from, sustained by or arising out of IIT’s exercise of said right, permission and license
and any undertakings, uses and disclosures associated therewith; and (ii) I hereby release all of
the above-named from any and all such liability.
I have read and understand the above provisions and am freely and knowingly agreeing to
be bound by them as indicated by my signature below. This Form shall be construed in
accordance with Illinois law, without regard to its choice of law principles, and jurisdiction for
any dispute related to this Form shall be heard in the courts located in Chicago, IL.
Name:____________________________________________________________
Date:_____________________________________________________________
Address:__________________________________________________________
Signature:_________________________________________________________
IIT GC Office March 2016