Photo Release Form-Legal_s revised6.doc: uploaded 28 January 2016 at 11:21 am

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Georgia Tech
Student and Teacher Enhancement Partnership (STEP) Program
Photographic Image Usage
Purpose of the photos
STEP staff members and graduate students will be taking pictures of the Georgia Tech graduate
students, high school students, and teachers involved in the STEP program. These photographs,
videotapes, motion pictures, or recordings (together referred to as “Images”) are strictly for the
use of the STEP program in publicizing, reporting, and evaluating the program. They will not be
used for any commercial purposes, and will not be used for publicity purposes by any
organization or person not affiliated with the STEP program, Georgia Tech, participating school
systems or the National Science Foundation.
Images will be used in or on:
 Multimedia presentations about the STEP program.
 Brochures about the STEP program.
 Web pages related to the STEP program.
 Other publicity material or reports generated by Georgia Tech, participating school systems,
the National Science Foundation, or other future financial sponsors.
Images may be copyrighted by Georgia Tech and used in future publications from the institute,
individually or in conjunction with other images.
Foreseeable Risks or Discomforts
Any photograph used by the STEP program for publicity will likely be viewed by many people
unrelated to the participating groups. In addition, there is a risk that photos placed on web sites
will be duplicated without permission from the site. Individual high school student identifiers
will NOT be attached to the photographs, although school, STEP graduate student, and teacher
names will be identifiable.
Benefits
STEP photographs will be used to benefit the program, school, school system, Georgia Tech, and
the National Science Foundation by bringing positive attention to the program and to the
participating individuals.
Compensation
No financial compensation will be provided to individuals whose images appear in STEP
photographs.
Confidentiality
No high school students will be identified by name in any STEP photographs unless specific
permission is given by the parents or guardians on a picture-by-picture basis.
Approved as to Legal Form by
Office of Legal Affairs 08/28/01
Financial Disclosure
There will be no personal financial gain from these photographs by any of the STEP participants.
Contact Person
If you have questions, call or write:
Dr. Donna C. Llewellyn
Center for the Enhancement of Teaching and Learning
Georgia Institute of Technology
Atlanta, GA 30332-0383
(404- 894-2340, phone
(404) 894-4475, fax
E-mail: donna.llewellyn@oars.gatech.edu
Please read and sign the attached release form and return to the participating teacher or school.
Keep these cover sheets for your records.
Approved as to Legal Form by
Office of Legal Affairs 08/28/01
Georgia Tech
Student and Teacher Enhancement Partnership (STEP) Program
Photographic Image Release Form
By signing below, you grant the Georgia Institute of Technology (GIT) and the Georgia Tech
Research Corporation (GTRC) the right and permission to take photographs, videotapes, motion
pictures, or recordings of you or your child in conjunction with the Student and Teacher
Enhancement Partnership (STEP) Program, to copyright these images, and to reproduce these
images for any legitimate purposes. You waive any right to inspect or approve the images before
their use.
By signing, you release GIT, GTRC, the Board of Regents of the University System of Georgia,
and the participating STEP school systems from responsibility for damages of any kind arising
from the use of the images, including claims for libel, invasion of privacy, or unauthorized
misuse of the images. This authorization and release shall benefit the heirs, legal representatives,
licensees, and other representatives assigned legal rights of GIT, GTRC, and the Board of
Regents of the University System of Georgia. This release shall be binding upon me and my
heirs, legal representatives, and any other person or representative to whom I assign my legal
rights.
_______________________________________
Student Name (Print & Signature)
__________
Age
______________________
Date
____________________________________________________
Address
______________________
Phone Number
____________________________________________________
Parent or Guardian’s Name (Print & Signature)
_______________________
Date
____________________________________________________
Address (if different from above)
_______________________
Phone Number
Approved as to Legal Form by
Office of Legal Affairs 08/28/01
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