2025 Photo Recording Release Form

TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER

PAUL L. FOSTER SCHOOL OF MEDICINE

PHOTO/RECORDING RELEASE

Child's Full Name

School

District

Grade

For good and valuable consideration, I authorize Texas Tech University Health Sciences Center – Paul L. Foster School of Medicine (the “University”) and its agents to record my child’s appearance and participation on video tape, audio tape, film, photographs, or any other medium and to use, reproduce, modify, distribute, and publicly exhibit such recordings, in whole or in part, without restrictions or limitation for any purpose that the University deems appropriate, including in connection with any product or service in all markets, media, or technology now known or hereafter developed as well as in advertisements, promotions and merchandising. I further consent to the use of my child’s name, likeness, voice and biographical material in connection with such recordings.

I represent that I am the parent/guardian of the above named child and that in that capacity University has my consent and authorization to use the name and/or likeness as described above.

By

Printed Name

Date