Appendix D - Sample Release Form

Appendix D – Sample Release Form

You may want participants to sign a release; consider modifying this for your use. Sierra Valley Digital Storytelling Project Release Form

 Thank you for participating in the RREA Sierra Valley Digital Storytelling Project (working title). Please fill in and sign this form to give us permission to use the images, photographs, documents, written materials, voice and sound recordings, and any other materials you have provided to go with your digital story.

Participant’s Name:____________________________________________________

Project Title:_Sierra Valley Digital Storytelling Project________________________

Producer:  Holly George, jesikah maria ross

Date:________________________________________________________________

I agree that my voice recordings and the images submitted, and taken during the project as well as my or my organization’s writings, documents, and photographs may be distributed by agents, employees or representatives of The Regents of the University of California (hereinafter called “the University”) without limitation through presentations, exhibition, website, book and internet publishing.

I understand that I am granting all rights to these documents and images without compensation to the University of California for educational, non-commercial use.

I hereby hold harmless and release and forever discharge the University from all claims, demands and causes of action which I, my heirs, representatives, executors, administrators or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

Date:________________                              By:_______________________

                                                                      Signature

 ____________________                                __________________________

Telephone                                                        Printed Name 

____________________                                __________________________

Email                                                               Street Address

                                                                 ________________________

                                                                      City      State    Zip