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PHOTO / VIDEO / AUDIO / WEBSITE / SOCIAL MEDIA RELEASE
Are you the parent or 18 years or older?
Parent
Self (18 years or older)
Working Project Title:
Child’s Full Name:
First
Last
Parent Name
First
Last
Name
First
Last
Address
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
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Colorado
Connecticut
Delaware
District of Columbia
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Armed Forces Americas
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ZIP Code
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Consent
By checking the box I agree to the following:
With my signature below, I hereby give consent for my child’s image, voice, name and/or family last name to appear in photographs, slides, video tape, DVD, film, audio tape, The Help Group website, The Help Group social media channels (including but not limited to Facebook, Twitter, Instagram) or any other known or future mediums (media materials) for use by The Help Group. I understand that any or all of these media materials may be used by The Help Group, its corporate entities and schools, for public relations, fundraising, training, demonstration, and/or any other business or educational purposes. I am aware and consent for the media materials to be distributed via any and all channels, including the Internet.
Consent
By checking the box I agree to the following:
With my signature below, I hereby give consent for my image, voice, name and/or family last name to appear in photographs, slides, video tape, DVD, film, audio tape, The Help Group website, The Help Group social media channels (including but not limited to Facebook, Twitter, Instagram) or any other known or future mediums (media materials) for use by The Help Group. I understand that any or all of these media materials may be used by The Help Group, its corporate entities and schools, for public relations, fund raising, training, demonstration, and/or any other business or educational purposes. I am aware and consent for the media materials to be distributed via any and all channels, including the Internet.
Signature
Date
MM slash DD slash YYYY
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