Rice University


Media Release Form


I hereby grant permission to Rice University to photograph/interview my child, ____________________________________________. 

I understand that, if displayed, my child's image will in no way be connected to his/her name.  I also understand that this photograph/interview or portions thereof may be used for public viewing in print and/or on the program website.  I understand that this agreement releases the photographer as well as Rice University from any future claims, as well as any liability arising from the use of these materials.



Full Name of Student    _______________________________________________

Address                       _______________________________________________

City, State, Zip _______________________________________________




Parent/Guardian's Printed Name                                                            


_______________________________________    ______/________/________

Signature of Parent/Guardian                                         Day  /  Month   /    Year