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PHOTOGRAPH, VIDEO, AUDIO AND SWIMMING GENERAL RELEASE FORM
Photograph, Video and Audio Release
I fully understand and agree that the Upward Bound Program may take photographs,
video recordings and/or audio recordings of participants and activities. I agree that the
University of Wisconsin-Stevens Point Upward Bound Program shall be the sole owner
of and may use such photographs, videos and/or audio recordings relative to the
promotion of similar programs. I relinquish all rights that I may claim in relation to the use
of said photographs, videos and/or audio recordings.
Furthermore, I authorize the Upward Bound Program to audio record or video any
meeting(s) or discussion(s) with my son/daughter or ward should they at any time
become involved in disciplinary proceedings. Audio and/or or video statements may also
be made from any and all Upward Bound students in regards to disciplinary proceedings
and accidents/injuries. Recording of such events shall be at the sole option of the
Upward Bound Program.
Swimming Release
I give my child permission to participate in waterfront activities while at a UWSP summer
camp. (Must check one)
 Yes
 No (check one)
My child does know how to swim:
 Yes
 No (check one)
My child’s swimming skill level is (check one):
 Beginner
 Intermediate
 Proficient
I have read and fully understand the above releases:
Parent/Guardian Name: ____________________________________________________________
(Please Print)
Parent/Guardian Signature: ___________________________________________ Date: ___________
Street Address: ___________________________________________________________
City: _________________________________ State: ________ ZIP: _________
Student/Camper Name: ____________________________________________________________
Camp Name: Upward Bound Program
08/2013