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APPENDIX 5C-VR3

Michigan 4-H Proud Equestrians Program
Parent/Guardian-Adult Volunteer Video,
Film and Photography Release Form
This form is valid for a period of one year from the date signed.
No individual can be accepted for as a volunteer in a Michigan 4-H Proud Equestrians Program until
this form has been completed by the rider’s parent(s)/guardian or by an adult rider who is a legaly
competent adult 18 years of age or over.
Note: Participation in a Michigan 4-H Proud Equestrians Program as a volunteer is not contingent on an
affirmative (yes) response on this “Parent/Guardian-Adult Volunteer Video, Film and Photography Release
Form.”
I authorize Michigan State University to record the image and voice of the subject named below and give MSU
and all persons or entities acting pursuant to MSU’s permission or authority, all rights to use of these recorded
images and voice. I understand that said images and/or voice will be used for educational, advertising and
promotional purposes in