Photography & Video Release Form

Grant Recipient

First Last

Parent Name

First Last

Date

Grant ID

Home Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

Phone

Photographic, audio or video recordings may be used for the following purposes:(Required)

• conference presentations
• educational presentations or courses
• informational presentations
• on-line educational courses
• educational videos
• foundation informational events and marketing materials

By authorizing this release I understand this permission signifies that photographic or video recordings of me/my child may be electronically displayed via the Internet or in the public setting. There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed. This release applies to photographic, audio or video recordings collected as part of the foundation's activities. By signing this form, I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for educational or promotional purposes.

I authorize

I do not authorize

Signature

If this release is obtained from a recipient under the age of 18, then the signature of that child’s parent or legal guardian is required.

Child's T-shirt Size

Always shake your Christmas tree outside before you bring it inside. You never know what critters are still attached to your tree. Make sure to get a Christmas tree that is not from a “Tick infested” area.