Volunteer Media Release and Authorization Statement

I understand photograph(s), or video(s), or audio recording(s) taken of me by agents, employees, or representatives of the Texas A&M AgriLife Extension Service and/or Prairie View Cooperative Extension Program (hereinafter called “the Agency”) shall be used in connection with the Agency’s dissemination of information by its public service and academic programs to the general public.

I hereby irrevocably authorize the Agency to copy, exhibit, publish or distribute any and all such images and audio of me or wherein I appear, including composite or artistic forms and media, for purposes of publicizing Agency programs or for any other lawful purpose. In addition, I waive any right to inspect or approve the finished product, including written copy, wherein my likeness appears.

I hereby hold harmless and release and forever discharge the Agency from all claims, demands and causes of action which I, my heirs, representatives, executors, administrators or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization, including claims arising from agencies negligences.

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By submitting this form, I authorize the Texas A&M AgriLife Extension Service or any of its components to make reference checks relating to my volunteer service. I understand that this information will be used to determine my eligibility as a volunteer with the Texas A&M AgriLife Extension Service.

By submitting this form, I indicate my desire to become a volunteer with the Texas A&M AgriLife Extension Service. I understand there are specific requirements for each Master Volunteer program. I am willingly agreeing to comply with the requirements of the respective program in which I am applying. The information I am providing in this application is true and accurate to the best of my knowledge.

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