Media
Release
Form

Personal Information

Applicable Social Media Platform usernames

For which brand are you submitting photos/videos?*


I confirm that I am at least 18 years of age, and I can sign this agreement.

If you are under 18 years of age, please check here.

*If the person is under 18 years of age, the parent or legal guardian must sign below.

I am the parent or legal guardian of:

and do hereby consent and grant my permission to all the foregoing.


Upload file:


By submitting, I do hereby authorize the Connecticut Department of Transportation (CTDOT) to use any photograph or video that I have taken and submitted for promotion of the CTDOT’s activities, properties, facilities or functions in any public format, including but not limited to publication in the CTDOT websites including the CTrides (a program of CTDOT) Website, CTrail Website, and on CTDOT’s or its programs’ social media accounts, such as on CTrides’ Facebook or Instagram accounts, in its brochures or other marketing collateral or other publications and/or press releases. I understand that such promotion will be disseminated to the public and may be copied or otherwise reproduced. I hereby release the CTDOT from any liability that may arise from the photograph, video or likeness of myself in such promotions, and from any liability that may arise from the dissemination of such promotions to the public or the use of the promotions by the public.
I have read this agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and have signed it freely and without any inducement or assurance of any nature. I intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid, the balance, not withstanding, shall continue in full force and effect. This agreement shall be governed and construed per the substantive laws, but not the laws of conflicts, of the State of Connecticut.

Thank you. Your request has been sent.

Skip to content