Sports Media Profile & Release

This form gathers personal, athletic, academic, and promotional information for new and returning Vincennes University student-athletes to support media guide bios, team promotion, and public recognition.
Title
A short description to explain the nature of a ticket.
Sports Media Profile & Release
New VU student-athletes, including transfers, should complete all required and relevant sections of this form. Multi-sport athletes need only fill out this form once per year, not once per sport.
Who is completing this form?
Who is completing this form?
Please list below which information you would like to be changed.

Student-Athlete Information

List the first and last name of the student athlete.
List the student athletes name phonetically: Malcolm Reynolds (MAL-kuhm REN-uldz), Inara Serra (ih-NAR-uh SER-ruh)
Enter the year of NJCAA Eligibility.
Type the date of birth for the Student-Athlete.
Student-Athlete Cell Number
Student-Athletes Email
Describe a person in history you would like to meet & why
Sport - Position - Event(s) played
List the first and last names of any siblings.
John and Lisa Jones, John Jones and Lisa Smith, etc. . .
River Tam - Firefly Academy - Dance / Gymnastics
Enter the Platform Name, User Handle, and if the University has permission to tag you as shown in the placeholder for all Social Media accounts.
List any individual or team honors/awards from your high school/previous school athletic career. (i.e. first team all-state, team captain senior year, school records held, player of the year, won state championship sophomore year, etc.)
List any high school or college activities/organizations you are/were involved with outside of athletics.
List any hometown newspapers, TV, or radio shows that you would like to receive news about your athletic career at VU (name & location).

Authorizations

Please read carefully & understand before you complete the acknowledgment
Please read carefully & understand before you complete the acknowledgment
Please read carefully & understand before you complete the acknowledgment (required)
Please read carefully & understand before you complete the acknowledgment
Please read carefully & understand before you complete the acknowledgment
Please read carefully & understand before you complete the acknowledgment (required)
Please read carefully & understand before you complete the acknowledgment
Please read carefully & understand before you complete the acknowledgment
Please read carefully & understand before you complete the acknowledgment (required)
Please read carefully & understand before you complete the acknowledgment
Please read carefully & understand before you complete the acknowledgment
Please read carefully & understand before you complete the acknowledgment (required)
Please read carefully & understand before you complete the acknowledgment
Please read carefully & understand before you complete the acknowledgment
Please read carefully & understand before you complete the acknowledgment (required)
Sports Record Release
I hereby authorize Vincennes University to release my intercollegiate participatory sports records to media outlets requesting such information for publication or other use. The released information may include the following: actual game statistics, pertinent personal data such as height, weight, position, age, hometown, college class status and past schools attended, comments for use in feature articles and photographs, films, drawings or slides, pertinent medical information in consultation with the head athletic trainer, doctor or coach. This information may also include records earlier forwarded to Vincennes University from high school and other colleges attended by me. Excluded from this information for release are any other academic records other than those of a positive nature such as for promotion with the mass media for conference or national athletic academic honors. Your grade point average may be used to highlight your achievement in print or online. 
Publicity Release
I hereby authorize Vincennes University absolute right and permission to reproduce, use, exhibit, display, broadcast, distribute, and create derivative works of University-related photographs, videotaped images, voice recordings, and name of the undersigned person, in whole, in part, of in composite, for use in connection with the activities of the University or for promoting, publicizing or explaining the University or its activities.
Promotional Release
I hereby authorize Vincennes University use of my image and/or likeness for promotional purposes with my consent. This authorization includes, without limitation, the right to publish such images in the University Web site, alumni magazine, and PR/promotional materials, such as marketing and admissions publications, advertisements, fund-raising materials, and any other University-related publication. These images may appear in any of the wide variety of formats and media now available to the University and that may be available in the future, including but not limited to print, broadcast, videotape, CD-ROM, DVD, and electronic/online media. I hereby waive any right that I may have to inspect or approve the finished product or products or the advertising copy or printed matter that may be used in connection therewith or the use to which it may be applied.
Liability Release
I hereby release, defend, indemnify and hold harmless Vincennes University Department of Athletics, its Trustees, officers, employees, and agents from and against any claims, damages or liability arising from or related to the use of the images, recordings or materials, including but not limited to claims of defamation, invasion of privacy, or rights of publicity or copyright infringement, or any misuse, distortion, blurring, alteration, optical illusion or use in composite form that may occur or be produced in taking, processing, reduction or production of the finished product, its publication or distribution. 
Acknowledgment & Consent
Clicking Submit signifies that you have thoroughly read and fully understand all the information presented in this form. This consent, waiver, indemnity and release is binding on me, my heirs, executors, administrators and assigns.This action is the equivalent of providing your handwritten signature and the current date.

 

Other Fields

Your name
Verification Code