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Videotape Release Form

Permission and Release Form to Videotape Guest Lecturer/Presenter




Event: _________________________________________________________________________


Please checkmark Yes/No for all questions 1-3.  This form also requires your signature on page two.


1.      I have the necessary rights and/or permissions to use the works of others.

                              Yes ________

                               No  ________


2.      I am willing to have my presentation available on Centre’s website, iTunes University, or any other 

   on-line video streaming service managed by Centre College.

                               Yes ________

                   No  ________  


3.      I am willing to have my presentation available on any Centre’s web presence, only if access is limited

   to individuals who work/attend Centre College.

                   Yes ________

                   No  ________  


I understand that this event is being videotaped, and I hereby grant permission for Centre College to include my presentations and comments, in any and all forms, in these records and recordings.  I further grant permission for Centre College to transcribe and reproduce these records and recordings, if Centre College chooses to, and for Centre College to distribute and/or make multiple copies of these records, recordings and transcripts, in complete or partial form, and in translation, on videocassette, broadcast, cablecast, CDROM, laser disc, multimedia, print, electronic text, and any other media format now or hereafter known.


I agree that Centre College has the right to use my image, voice, pronouncements, and likeness recorded herein, and my name and any and all biographical material submitted by me in connection with the Event named above, for purposes of the reproduction and distribution described above, and for any associated advertising or exhibition, whether used in excerpts or in full.


I understand that Centre College and others will invest considerable resources in reliance on the permissions and releases herein.  I understand that Centre College is under no obligation to exercise any or all of the rights, licenses, or privileges herein granted.  I hereby release and discharge Centre College and other Event sponsors, funders, and organizers from any and all liability arising out my participation in the Event, or in connection with the performance of any of the activities described in this document as permitted herein, including but not limited to my rights of privacy or publicity, copyrights, patent rights, trade secret rights, moral rights, or trademark rights.


All permissions granted by me and all releases by me herein shall be effective in perpetuity and throughout the universe.  All permissions and releases herein extend and apply to Centre College and its assigns, contractors, sublicenses, distributors, successors, and agents.


In the event that any materials used in my presentation contain the work of other individuals or organizations (including any copyrighted musical compositions or excerpts thereof), I understand that it is my responsibility to secure any necessary permissions and/or licenses. Small performing rights licenses must be secured for the public performance of any copyrighted musical compositions in film or video presentations.



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Signature                                                                                                                          Date