Texas Tech University Upward Bound Programs
MARKETING PARTICIPATION & INTERNET RELEASE FORM
This form will serve as the ONLY waiver valid for ALL Upward Bound (UB) Program activities occurring
September 1, 2015 through August 31, 2016
The Parent/Managing Conservator/Guardian (circle one) of the Minor Child hereby give permission for the name of said
Minor Child to be released to the media or for him/her to participate in any media coverage that might transpire during
the course of the Upward Bound Program. I authorize the use of the Minor Child’s name, biography, likeness, voice and
performance in the production of the program(s) and for the purpose of publicizing and promoting the program(s) for
use on the program’s website, Facebook page, printed literature or any other marketing tool used.
I represent that I am a Parent/Managing Conservator/Guardian of the Minor Child whose name is listed above, and I
hereby agree to have my child participate in media coverage.
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MY CHILD MAY PARTICIPATE IN MEDIA COVERAGE
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MY CHILD MAY NOT PARTICIPATE IN MEDIA COVERAGE, and I do not wish his/her name to be released to the
news media.
I hereby grant permission for my child to access networked computer services such as Internet, World Wide Web,
electronic mail, and any other website at the computer labs of Texas Tech University. I understand that students will
have unrestricted access to the Internet while on the TTU campus.
______________________
Date
Student’s Printed Name
Student’s Signature
Parent or Legal Guardian’s Printed Name
Parent or Legal Guardian’s Signature
______________________
Date