Youth Advisory Committee Media Release Form printable pdf download

Youth Advisory Committee Media Release Form

Youth Advisory Committee

Media Release Form

Please provide all the information asked for below.

Name: _____________________________________________________________________________

Home address: _____________________________________________________________________

Please check all that apply:

This material will be used in the form of

____ News Release

____ Photographs

____ Video

____ Audio

____ Website

to be used by [Community Foundation] for [Period of Time] from the date of this release for the purpose of

promoting youth philanthropy.

IF PERSON BEING USED IN THE MATERIAL IS UNDER I8 YEARS OF AGE, PARENT OR LEGAL

GUARDIAN MUST SIGN THIS FORM.

I (we) give my (our) permission to the [Community Foundation] to use my name (or my child’s name),

foundation, and/or photograph, videotape, or any likeness for publicity and the use of statements made by

or attributed to me (or my child) relating to the [Community Foundation] for this or similar promotions and

grant to the [Community Foundation] any and all rights to said use without further compensation. It is my

(our) understanding that my signature below releases the [Community Foundation] from any financial or

legal responsibility for the use of this media relations/promotional material(s).

Signed: __________________________________ Permission granted: _________________________

Date: ____________________________________ Relationship: _______________________________

Youth Advisory Committee Media Release Form