Media Release Consent Form : Minor
Please Fill out One consent form per child 

Urban Utopia's Inclusive/Community Engagement Events
San Diego County, CA.
Contact us at (619) 289- 8296 or urbanutopiaorganization@gmail.com 
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Email *
Parent/Guardian Name *
Minor Child Name *
Minor Child Date of Birth *
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Name of Event Attending *
Media Release: I grant permission for me to be included in the use of the following formats for the purpose of publicity of Urban Utopia LLC community without further permission from me - photographs, videos, and audio recordings used by Urban Utopia LLC and media such as social media (Instagram, Facebook, etc.), Urban Utopia LLC website. I will list below any exceptions to this release (e.g. "Pictures of me can be posted on social medias and websites associated by Urban Utopia LLC ONLY, but may not be posted or published anywhere outside of Urban Utopia LLC's affiliation". )
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Required
I understand that I may revoke or invoke my consent in writing at any time. If I choose to invoke or revoke a permission or release, it is my responsibility to provide written notification to Urban Utopia LLC by email at urbanutopiaorganization@gmail.com 
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Required
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