Media Release Form

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Student's Name* This field is required.

First Name

Last Name

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School Name* This field is required.

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Parent/Guardian Name* This field is required.

First Name

Last Name

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Consent to Media Release* This field is required.Check the box for consent

I hereby grant Alpha Kappa Alpha Sorority, Incorporated/ Bakersfield Ivy Legacy Foundation (AKA/BILF) and their agents the absolute right, title and interest to and permission to copyright, use, publish and republish the name, voice, picture and likeness to digital images or videotapes of My Student listed above (collectively, "likeness"), or in, which My Student listed above may be included in whole or part, or reproductions thereof in color or otherwise for any lawful purpose whatsoever, including but not limited to use in any AKA/BILF publication or on the AKA/BILF websites, without payment or any other consideration. I hereby waive any right that I may have to inspect and/or approve the finished product or the copy that may be used in connection therewith, wherein My Student listed above's likeness appears, or the use to which it may be applied. I hereby release, discharge, and agree to indemnify and hold harmless AKA/BILF and their agents from all claims, demands, and causes of action that I or My Student listed above have or may have by reason of this authorization or use of My Student listed above's likeness, including any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking or in processing tending towards the completion of the finished product, including publication on the internet, in brochures, or any other advertisements or promotional materials. We/I hereby certify that We/I are/am the parent(s) or guardian(s) of the above-named child and do hereby give our/my consent without reservation to the foregoing on behalf of My Child.

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Parent/ Guardian Signature for Consent of Media Release* This field is required.Use your mouse to sign below.

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Date* This field is required.

Date