Ram Statue

Student Model Form

Photographs, Videos and Recordings Consent Waiver,
Indemnity, Release, and Covenant not to Sue

I hereby grant permission to Winston-Salem State University and its representatives to take photographs or videos of me and to make recordings of my voice at the event or location noted below:


I further grant to Winston-Salem State University and its representatives the right to reproduce, use, exhibit, display, broadcast and distribute and create derivative works of these images and recordings in any media now known or later developed for such purposes and Winston-Salem State University deems fit.

I acknowledge that Winston-Salem State University owns all rights to the images and recordings in any medium.

I hereby waive any right to inspect or approve the use of the images or recordings. I further waive all moral rights. I also waive any right to royalties or other compensation arising from or related to the use of the images, recordings, or materials.

I hereby release, waive, forever discharge, and covenant not to sue Winston-Salem State University, its governing board, officers, agents, employees, and any students acting on behalf of University from and against any claims, damages or liability arising from or related to the use of the images, recordings or materials, including but not limited to claims of defamation, invasion of privacy, rights of publicity or copyright infringement, or any misuse, distortion, blurring, alteration, optical illusion or use in composite form that may occur or be produced in taking, processing, reduction or production of the finished product, its publication or distribution.

 I hereby acknowledge that this consent, waiver, indemnity, release and covenant not to sue is binding on me, my heirs, executors, administrators and assigns.

I have read this document before signing below, and I fully understand the contents, meaning and impact of this consent, waiver, indemnity, release, and covenant not to sue.

Winston-Salem State University

601 S. Martin Luther King Jr. Drive

Winston-Salem, NC 27110

Phone: (336) 750-2000



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