Photograph Release Form

I hereby grant to Centre College the irrevocable and unrestricted right to use and publish photographs of me, or in which I may be included, for College publications, electronic reproductions and/or promotional materials or any other purpose and in any manner or medium.

In addition, I grant my permission to alter the same without restriction; and to copyright the same. I hereby release the photographer and Centre College from all claims and liability relating to said photographs.

Printed Name: __________________________________________                                         Date: _________________

Signature: _____________________________________________                                           Phone: ________________

Address: ___________________________________________________________________

City: __________________________________                  State: ___________                    Zip: ____________