RELEASE FORM – Photo

I, _________________________________________________ (print full name) hereby authorize Confederation College, or anyone authorized by Confederation College to use my photograph for promotional purposes.

SIGNATURE:  ___________________________________  Date:  ___________
                                                    (required)

•	Program of Study: _______________________________________________

•	Expected year of graduation: ____________

Contact Information:  (Optional - for follow-up purposes, if necessary)
e-mail address:  __________________________________________________
Phone #:  __________________________ (h)    Alternate Phone: _________________________

RELEASE FORM – Photo

I, _________________________________________________ (print full name) hereby authorize Confederation College, or anyone specified by the college to use my photograph for promotional purposes.

SIGNATURE:  ___________________________________  Date:  ___________
                                                    (required)

•	Program of Study: _______________________________________________

•	Expected year of graduation: ____________

Contact Information:  (Optional - for follow-up purposes, if necessary)
e-mail address:  __________________________________________________
Phone #:  __________________________ (h)  
Alternate Phone: _________________________