Media Consent FormCONSENT TO PHOTOGRAPH, FILM, OR VIDEOTAPE FOR NON-PROFIT USE(e.g. educational, public service, or health awareness purposes)I hereby consent to the participation in interviews, the use of quotes, and the taking of photographs, movies or video tapes of Myself, My Child, and all other participating Family Members.I hereby also grant the right to edit, use, and reuse said products for non-profit purposes including use in print, on the internet, and all other forms of media. I understand that Prevention Links has no obligation to use my name, likeness, or voice in the materials it produces, but if Prevention Links so decides to use them, I acknowledge that it may edit such materials. I hereby waive the right to inspect or approve any such use, either in advance or following distribution or display.I hereby unconditionally release Prevention Links and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above.By signing below, I represent that I am of legal age, have full legal capacity, and agree that I will not revoke or deny this agreement at any time.I have read the foregoing and fully understand its contents.Please type your name and the date below if you agree: *
Please tell us about your family. Name of family members, age, relation to you and separate by a comma if more than one.
