Media Release Form

(INSERT Organization NAME)

MEDIA RELEASE FORM

By signing below I, Mr./Mrs./Ms.

(client name)

authorize the organization identified above to photograph the interior and exterior of my

home, myself, my family, and any work performed by the Weatherization Assistance

Program.

I understand the photos will be used for informational and instructional purposes only

and will not be used to generate a profit or for any other commercial purposes. I

understand the photos may be used throughout the country by other local, state and

federal agencies for informational and instructional purposes. I have not been

compensated nor will I seek compensation for the photos. I release the organization from

responsibility should a third party violate the terms of this release.

Signature

Date

Witness

Date

0 votes

Parent category: Legal