Hometown Release Form

*Denotes Required Field

*First Name

Preferred First Name/Nickname
(If different from First Name above)

*Last Name

*Student ID
(Can be found on your acceptance letter)

*Email Address
(Please use your Marietta College email address)

Birthdate

Preferred pronoun (example he, she, they)

Parent/Guardian #1 First Name

Parent/Guardian #1 Last Name

Parent/Guardian #1 Email

Is this person an alumnus/alumna of Marietta College?

Parent/Guardian #2 First Name

Parent/Guardian #2 Last Name

Parent/Guardian #2 Email Address

Is this person an alumnus/alumna of Marietta College?

*I authorize the Marietta College Office of Communication & Brand Management to use my information in news releases to my hometown media.

Yes

*I give Marietta College the absolute right and permission to use a photograph(s) of me in its promotional materials and publicity efforts and understand that the photographs and/or videos may be used in a publication, print ad, direct-mail piece, electronic media (e.g., video, internet, social media), or other form of promotion, therefore releasing the photographer, the College, their offices, employees, agents and designees from liability for any violation of any personal or proprietary right I may have in connection with such use.

Yes

*Signature
Parent or Guardian if student is under the age of 18
(By typing your name you are giving us your signature)

*Date of Signature