Genesis Hopeful Haven Media Release Form
Participant Name:
Address:
City:
State:
Zip:
By signing this form, I give Genesis Hopeful Haven permission to copyright, publish, or use any and all photographs which you take or have taken of me, or my property, or in which I may be included in whole or in part.
I waive any right to inspect or approve the finished product or the editorial copy that may be used in connection with my photos, or the use to which it may be applied.
I hereby release, and agree not to hold Genesis Hopeful Haven or any associated stakeholders to any liability by virtue of any blurring, distortion, alteration, retouching, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in reproduction of the finished product.
I am over 18 years of age
Participant Full Name (Printed):
Date:
Participant Signature:
If minor or not their own guardian, parent or guardian must sign below.
I hereby certify that I am the parent or guardian of above mentioned individual land and give consent without reservations to the foregoing contract on behalf of him or her.
Parent/Guardian Full Name (Printed):
Email:
Phone:
Parent/Guardian Signature:
FOSTERING NEW BEGINNING