Adult Publication/Audio/Video Release Form Sample Contracts
Form AP/VRAdult Publication/Audio/Video Release Form • April 17th, 2017
STATE OF HAWAII DEPARTMENT OF EDUCATION Adult Publication/Audio/Video Release Form This form combines and replaces the previous Adult Permission to Videotape/Record and Reproduce Work Forms. By signing this form, you agree to the terms and conditions of this agreement. Please complete the following: 1. Print all of the following requested information legibly. Use blue or black ink.2. Check the appropriate box below.3. Sign the “Signature” line.4. File with your school’s secretary, or your complex area or state office branch secretary, accordingly. I hereby give my permission to the Hawaii State Department of Education (HIDOE) to use my work, video recording, or otherwise record my name, voice, and/or likeness in its publications. I understand that examples of my work and/or these recordings of me will be used exclusively for non-commercial, educational purposes, which may include, but is not limited to, distribution by print, internet, or digital media and open-circuit broadcast, clo