Media Photo, Video Consent Form

Marketing Media, Photo and Video Consent Form (e.g. educational, public service, or health awareness purposes)
I grant permission to Kids' Food Basket and its agents and employees the irrevocable and unrestricted right to reproduce the photographs, and/or video images taken of me, for the purpose of publication, promotion, illustration, advertising in any manner or in any medium. I hereby release Kids' Food Basket and its legal representatives for all claims and liability relating to said images or video. Furthermore, I grant permission to use my statements that were given during an interview or guest lecture, with or without my name, for the purpose of advertising and publicity without restriction. I waive my right to any compensation. I also hereby release Kids’ Food Basket and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above.
Parent Name*
First Last
I hereby consent to the participation in interviews, the use of quotes, and the taking of photographs or videos.
Student Name*
First Last
I hereby consent to the participation in interviews, the use of quotes, and the taking of photographs or videos.
Name of School, Organization or Group if Applicable
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email
Signature of Participant or Parent/Guardian (if Student is under 18)
Name*
First Last
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Marketing Media, Photo and Video Consent Form (e.g. educational, public service, or health awareness purposes)