Empower And Excel - Media Permission Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

EnE- Media Permission

Read the terms, and by entering your name into the box below, you confirm your affirmation of the policies outlined below. This constitutes your digital signature. *

I hereby consent to the use of photographs/videotape taken during the course of the Empower and Excel team’s volunteer work for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet, social media or other media sources). I do this with full knowledge and consent and waive all claims for compensation for use, or for damages.

Yes, I give consent for Empower and Excel, non-profit organization to photograph myself for volunteer work purposes and/or at volunteer events.

Required

Name *

Facility Name

Email Address *

Phone Number *

Digital Signature *

Parent/Guardian's Digital Signature for under 18 *

Check the following box to acknowledge that you have read and agree with all the terms, policies, and guidelines set forth in this document. *

Yes, I agree.

Required

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms