Athletic Communications Student-Athlete Questionnaire

FOR CURRENT UT ATHLETES ONLY, this is not a form for potential recruits.

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Ex. Tampa, FL
if necessary
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For Swimming, Cross Country and Track: Please list event and top times
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Men's Sports Only
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Baseball and Softball
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Phone, Text, Email
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ex. Tampa, FL
If separated/divorced, list all
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Photo/Video Release

I hereby grant to The University of Tampa absolute right and permission to reproduce, use, exhibit, display, broadcast, distribute and create derivative works of University-related photographs or videotaped images of the undersigned person, in whole, in part, of in composite, for use in connection with the activities of the University or for promoting, publicizing or explaining the University or its activities.

This permission includes, without limitation, the right to publish such images in the University Web site, alumni magazine, and PR/promotional materials, such as marketing and admissions publications, advertisements, fund-raising materials, and any other University-related publication. These images may appear in any of the wide variety of formats and media now available to the University and that may be available in the future, including but not limited to print, broadcast, videotape, CD-ROM, DVD, and electronic/online media.

I hereby waive any right that I may have to inspect or approve the finished product or products or the advertising copy or printed matter that may be used in connection therewith or the use to which it may be applied.

I warrant that I am at least 18 years of age, and I am competent to contract in my own name. I further state that I have read the above authorization, release and agreement, prior to its execution, and that I am fully familiar with the contents thereof.

Buckley Amendment Release

I agree to allow UT athletics to release this information to the media/public for the purpose of promoting my team and myself in a positive manner. In case that I am an honor student, eligible for academic awards, UT has permission to release my GPA as a defining criteria for such awards. I have been informed of the Buckley Amendment in regard to my rights to privacy as a student at The University of Tampa.

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* = required field