Consent to Document or Record Electronically

Version 3.0; 05/24/2005

I permit the Regents of the University of Michigan (University) to create photographs, videotape, film, audio recordings, web-cast or cable-cast content, or otherwise document and record my participation at the University of Michigan School of Music, Theatre & Dance for educational, academic, or research purposes.

If the University determines that education or research may benefit from the use of these materials, including any materials already in its possession, the University may publish or sell the materials for academic purposes or use them in any other professional manner that the University believes is proper. I understand and agree that the University has my permission to use and distribute my name, likeness, image, performance, voice, appearance, and/or recorded participation, that the recorded materials belong to the University, and that I will not receive payment or any other compensation in connection with the recorded materials.

I have had a chance to discuss this form with the University of Michigan staff and have received complete answers to all my questions.

I release the University of Michigan from any and all liability that may or could arise from the recording of my image or performance.

All fields marked * are required.

AGREE or DISAGREE to Give Consent