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Student ID #:
Name:
 
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* A late registration fee of $10 will be applied if payment is received AFTER the registration deadline.     CVC Code:
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Model Release
(Acknowledgement Required)
  Interpreter's Law
(Acknowledgement Required)
  Name/Birthdate:

In consideration for value received, receipt whereof is acknowledged, I hereby give The Betty and Leonard Phillips Deaf Action Center of Louisiana the absolute right and permission to copyright and/or publish, or use photographic portraits or pictures of me, or in which I may be included in whole or in part, or composite or distorted in character or form, in conjunction with my own or a fictitious name, or reproductions thereof in color or otherwise, made through any media a the Center or elsewhere, for art, advertising, trade or any other lawful purpose whatsoever.
I hereby waive any right that I may have to inspect and/or approve the finished product or the advertising copy that may be used in connection therewith, or the use to which it may be applied.
I hereby release, discharge, and agree to save the Betty and Leonard Phillips Deaf Action Center of Louisiana from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or by produced in the taking of said pictures, or in any processing tending towards the completion of the finished product.
  According to present Louisiana Law it is illegal for any individual to call themselves an interpreter or engage in the act of interpreting unless certified by the State of Louisiana or by the Registry of Interpreters for the Deaf.  The only area of exception is in the religious setting.
I acknowledge by my name and birthdate above that the above information has been given to me in writing and/or explained to me by the Betty and Leonard Phillips Deaf Action Center of Louisiana
.
     

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601 Jordan Street | Shreveport, Louisiana 71101-4748 | 318-425-7781
 
Copyright (c) 1982 | The Betty and Leonard Phillips Deaf Action Center