Publication Release Form

Writ-Technik Student Publication Release Form

The form below indicates approval for the student’s name, picture, art, written work, verbal statements, or portraits to appear in program publicity, publications, videos, or on educational agencies’ web sites. For example, pictures, and articles about the “Young Writers’ Workshop” might appear in local newspapers, in student-published anthologies, or on program-affiliated websites. These pictures and articles may or may not personally identify the student. The program sponsors may continue to use the pictures and/or videos in subsequent years.

AGREEMENT*
- NEITHER in the print edition or online at Writ-Technik.com
- BOTH in the print edition and online at Writ-Technik.com
- ONLY In the Writ-Technik print edition
- ONLY at writ-technik.com
The Student (and Parent/Guardian) release to Writ-Technik the student’s name, picture, art, written work, and consent to their use and possible publication:
Please check here if you would like a print copy of the issue.
- Yes, I would like a print copy.
For author protection, these guidelines will be followed:*
- Remove the author’s bio and photo.
- Include the author’s bio and photo in the publication.
- • The author’s name, supplied biography, photograph, art, and written work shall only be used for the above indicated publication, academic presentation and future classroom instruction.
- • Authors will not be identified by personal details other than first and last name, except as self identified in their submitted author biography.
Please indicate if you would like the author’s bio and photo removed prior to publication:
Consent*
The author understands and agrees that:
- • No element of a student’s grade is based on acceptance of these terms;
- • They assert they have submitted only their own work;
- • No remuneration or compensation (i.e.: money) shall be paid;
- • Consent and release have been given without coercion or duress;
- • This agreement is binding upon heirs and/or future legal representatives;
- • This is not a guarantee of publication;
- • The authors retains ownership of the work and is encouraged to submit it for publication elsewhere.
- • Student material may be used in subsequent years as instructional examples.
Student's Name*
First Last
Student's Signature*
Date*
MM slash DD slash YYYY
For students under the age of 18, parents or guardians must also sign this form.
Name of Parent/Guardian
First Last
Signature of Parent/Guardian

Writ-Technik Student Publication Release Form

For students under the age of 18, parents or guardians must also sign this form.