Media Consent Form

    PHOTOGRAPH/MEDIA CONSENT AND RELEASE I hereby consent and authorize an employee or agent of Roseman University of Health Sciences (“Roseman”) to take photographs or motion pictures of me; or to produce videotapes, audiotapes, closed circuit television programs, broadcast television programs, webcasts, or other types of media productions that capture my name, voice, and/or image (any of the foregoing types of media are called the “Materials” in this Consent and Release form).

    I authorize Roseman to copyright the Materials, and I authorize Roseman to use, reuse, copy, publish, display, exhibit, reproduce, license to third party, and distribute the Materials in any educational or promotional materials or other forms of media, which may include, but are not limited to university publications, catalogs, articles, magazines, recruiting brochures, websites or publications, electronic or otherwise, without notifying me. I agree that I am participating on a voluntary basis and I will not receive any payment from Roseman for signing this release or as a result of any publication of the Materials.

    By submitting this form, you acknowledge: You are 18 years of age. You are providing consent on behalf of yourself or a child (under the age of 18) for which you are a parent or legal guardian.