Photo and Verbal Feedback Release Form

We know it's important to create opportunities for the Daemen community to share their experiences, now more than ever. As part of that effort, we're gathering pictures and stories to include in messages that showcase our culture.

Please take a moment to complete this permission form so we know it's okay to use your image and feedback in our marketing materials.

By submitting this form you grant permission to Daemen University to use and publish my photograph(s), electronic media image(s), written and verbal feedback (including direct quotes), in any presentation whatsoever, for educational and promotional purposes, without compensation.

First Name

Last Name

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Street Address

Street Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

IF you are a parent or guardian of the participant, please provide your name and contact information:

Parent of Guardian First

Parent of Guardian Last

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Parent or Guardian Phone

Parent or Guardian Email

I’m interested in future market research conversations with Daemen University

Electronic Signature

By checking this box, you agree your electronic signature is equivalent to your handwritten signature, and you consent to the terms above OR, if the participant is under 18, by checking this box, you indicate that you are the parent or guardian, and you are signing on behalf of this person.

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