Media Release Form

Step 2 of 5

    I understand that any photo, video, or testimony may be informational, instructional, or used during fundraising or for any other commercial purposes. I have not been compensated; nor will I seek compensation for said media. I release the organization from responsibility should a third party violate the terms of this release.


    By checking this box and typing my name above, I am electronically signing this release form. I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
    I consent to my submitted data being collected and stored.

    (NOTE: These checkboxes MUST be checked in order to submit the form.)