PHOTO & VIDEO
RELEASE FORM
I give Miami-Dade County permission to use, for promotional purposes, any picture, live
television, video tape or audio recording of me captured while participating in county
programs or events or campaigns.
I fully understand that my likeness may appear in booklets, brochures, print advertising, web
sites, and videos promoting Miami-Dade County.
I fully understand that I will not be compensated for the use of my image.
I hereby state that I am 18 years old or older.
I understand and fully agree to the terms and conditions of this release:
Student Signature: Date:
Print Name:
Home Address: ____________________________________________ Phone:
Email Address: _____________________________________________
Name of High School: ____________________________________ Grade Level: _________________
I understand and fully agree to the terms and conditions of this release:
Signature of parent/guardian for minors under the age of 18:
Date:
Print Name:
Address: _______________________________________________ Phone:
