FitWell Photo Release Form

I understand that the University of Wisconsin-Milwaukee (“UWM”) may take photographs, video, audiotape and other image and sound-based media of its employees, students, and third parties (collectively, the “images”). UWM may wish to use such Images to printed publications and on its website.

Therefore, I hereby freely and voluntarily consent to the use of the use and publication of my name, participation, picture, and/or likeness by UWM and/or its employees and/or agents for any and all purposes including, but not limited to, educational, promotional, advertising, and trade, through any medium or format as technology may now or in the future allow, including, but not limited to, videotape, audiotape, webcasting, podcasting, film, photographs, television, radio, digital, internet, theater, or exhibition, at any time from this date forward. I further waive any claims against UWM and/or its employees and/or agents based upon or related to its use or publication of my likeness, voice, participation, and/or picture.

I understand that this form is optional and I am not required to sign it. By entering my name and email address below, I freely give this authorization without expectation of compensation.

This form is a basic web-based form so if the form doesn’t work for you, please try another browser or different device. (No UWM login is required so it can be done on most devices and most browsers.)

Semester/Class Starts(Required)

Please choose the Semester & when your class starts from the drop down.

Class Title(Required)

Please make sure to select the correct information & fill this entire form correctly. Failure to complete the form correctly will result in not being able to participate in the class until the form is re-submitted with accurate information. You can find all the details needed in PAWS or Canvas.

Instructor Name(Required)

Please double check your instructors name is the name of the primary instructor.

Student's Name(Required)

First Last

Student's UWM Email(Required)

Please enter your @uwm.edu email address. No other email addresses will be accepted.

Expected Semester Graduating(Required)

Expected Year of Graduation(Required)

Authorization method(Required)

Authorize by providing your signature

Authorize by typing your full name

Student's Full Name – Photo Release(Required)

Signature of Student – Photo Release(Required)

Date(Required)

Comments

This field is for validation purposes and should be left unchanged.