Photo And Interview Release Form printable pdf download

Photo And Interview Release Form

Photo and Interview Release Form

Date _______________________

I hereby grant the The Center for Developmental Disabilities Advocacy and Community

Supports (The Center) permission to interview me and/or to use my likeness in

photograph(s)/video in any and all of its publications and in any and all other media,

whether now known or hereafter existing, in perpetuity, and for other uses by the The

Center. I will make no monetary or other claim against the The Center for the use of the

interview and/or the photograph(s)/video.

Name (print full name)_______________________________________________________

Signature_________________________________________________________________

Relation to subject (if subject is a minor)________________________________________

Address _________________________________________________________________

City, State, ZIP ____________________________________________________________

Telephone________________________________________________________________

Photo And Interview Release Form