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In the News
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For Patients
Ways To Help
Nursing @ ODU
Contact Us
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Media Release Form
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I hereby agree to the following terms:
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The undersigned agrees to give permission to Old Dominion University to use their image in video and/or photography for the purpose of publicizing ODU, ODU Community Care and ODU School of Nursing in any general University promotions, which could include the University Web site; publications which include the print admissions package, brochures, magazines, video, television, newspaper, newsletters, and/or publications that may act as fundraising ventures for ODU Community Care and the School of Nursing. The photo/video may or may not contain a caption identifying any individuals, although one may occasionally accompany the picture.
1. YOUR AGREEMENT
By agreeing to this media release form, you agree to be bound by, and to comply with, these Terms and Conditions. If you do not agree to these Terms and Conditions, please do not use tick the box.
PLEASE NOTE: We reserve the right, at our sole discretion, to change, modify or otherwise alter these Terms and Conditions at any time. Unless otherwise indicated, amendments will become effective immediately. Please review these Terms and Conditions periodically.
The Media Can Be Used in the Following:
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Videos
Photos
Email Marketing
Social Media
Newsletters/Magazines
Website
Other
Tick all that apply
If other, please specify
Signature of Individual to be Photographed/Videoed
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Clear Signature
Print Name
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First
Last
Is the person to be photographed/videoed under 18 years of age?
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Yes
No
Signature of Parent if Individual is under 18 years of age
*
Clear Signature
Print Name
*
First
Last
Date
*
Contact Information
Email
*
Phone
*
Submit
