I, name hereby agree that the Jewish Council for the Aging® (JCA) may take pictures and/or video of me and use them in newspapers, newsletters, magazines, annual reports and brochures, as well as on television, the JCA website, social media and in other media, including those of other partner organizations, without restrictions or time limitations.  I understand that in most cases I will not be identified by name in any photograph or notified of its use. My signature on this form also indicates my consent to access and participate in KC LIVE groups on Zoom with Kensington Club staff and volunteers. These groups could be recorded and used for JCA teaching or marketing purposes, including those of other partner organizations, without restrictions or time limitations.

Signature of Care Partner name
Signature of Club Applicant name