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Print Blank Release Form (English) Descargar formulario en español

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Rise CAM Photo & Media Release

I hereby authorize Rise Life Services, its representatives, staff, and authorized agents to photograph and/or record the above-named individual while participating in programs, activities, events, or community outings.

I grant permission for Rise Life Services to use the individual’s name, image, voice, and likeness for program-related purposes, including but not limited to newsletters, social media, website content, marketing materials, and program displays or presentations.

I understand that:

• Participation in photography and video recording is voluntary.
• I may request that photography or recording be stopped at any time.
• I may revoke this authorization in writing at any time for future use.
• Refusal to sign this form will not affect the individual’s services in any way.

This authorization shall remain in effect for a period of ten (10) years from the date signed unless revoked in writing.

By signing below, you acknowledge that you give permission for Rise Life Services to photograph and/or record the participant named below and use those images as described above.

 

By typing your full legal name, you acknowledge that this electronic signature represents your authorization as described above.
Please list any specific restrictions or instructions regarding photography, video recording, social media, website use, or other media use. Leave blank if there are no restrictions.
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