Highlands College Appearance/Performance Release Form

Title of Production:

Name of Project Leader:

Your Name:

Your E-Mail Address:

Your Contact Phone Number:

(Only if Under 18) Parent's Name:

(Only if Under 18) Parent's Email Address:

(Only if Under 18) Parents Contact Phone Number:

By Ticking this Box, I Hereby affirm that my appearance/performance in the above mentioned college/student production took place with my full consent freely given. I give to Highlands College in perpetuity all rights to use the said appearance/performance, and I release Highlands College from any liability to me in respect of the said appearance/performance.

Please Sign in the Box Below: (If using a tablet or phone with your hand. If using a computer, please use your mouse)

(If you are under 18) Parent, Please Sign in the Box Below: (If using a tablet or phone with your hand. If using a computer, please use your mouse)