Adult Education Center Multi-Media Form

  • ____________________________________________________________(please print), grant permission to the Adult Education Center and its agents and employees the unrestricted right to reproduce the photographs and/or video images taken of me for the purpose of publication, promotion, illustration, advertising in any manner or in any medium. I hereby release the Adult Education Center and its legal representatives for all claims and liability relating to said images or video. Furthermore, I grant permission to use my statements that were given during an interview, with or without my name, for the purpose of advertising and publicity without restriction. I waive my right to any compensation.

  • If legal guardian of model(s), please list name(s) here:

  • Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.