REP4/GVSU Release Form

(This agreement fully represents all terms and considerations and no other statements, conditions, or promises are made in conjunction with this release form.)

I give permission to Grand Valley State University (GVSU), to use, without charge and without reservation, my likeness in any medium and for any lawful purpose, including promoting the institution, its programs and services. I waive any rights of action I may have and release GVSU and its licensees from any and all claims I may have arising from use of my likeness, including any rights to sue for defamation or violation of my rights of privacy or publicity. 

I understand that my likeness may be used to promote the GVSU affiliated  REP4 initiative, which may include national news and marketing efforts. 

This release form covers photo and video usage in perpetuity. 

 

* denotes a required field

Participant First and Last Name: *

Signature of Participant *

I have read and agree to the statements listed above:

Phone Number: *

Email Address: *

REP4 Host Institution:
- Select Option Amarillo College Boise State University Fort Valley State University San Jose State University Shippensburg University Grand Valley State University Not listed Please specify a value for REP4 Host Institution:

Human Verification *