PERMISSION FOR THE RELEASE OF INFORMATION
I, the undersigned, authorize Siena Heights University, to release my intercollegiate participatory sports records to the media requesting such information for publication or other use. I further authorize the institution to release such information which may include records earlier forwarded to this institution from high school and other colleges attended by me to the media by the SHU sports information office.
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. 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. I authorize Siena Heights University to use my image and/or likeness for promotional purposes with my consent.