Media Consent Form

Media Consent Form
Re: blank (Name of Child/Youth)
I hereby Do/Do Not give consent: to Big Brothers Big Sisters of the Fraser Valley to use any photographs, audio and/or video recordings of my child as taken or produced by media personnel and/or agency members and/or agency staff for the purposes of promotional material including brochures, audio visual productions and all social media promotion. I further waive any claim which I may have against Big Brothers Big Sisters of the Fraser Valley arising from the use of such photographs, audio and/or video recordings of my child, as aforesaid.

DoDo Not
Signature of Parent/Guardian/Caregiver

Clear
Name of Parent/Guardian/Caregiver

First NameLast Name
Date

MonthDayYear
Date
Note: It is the parent/guardian/caregiver’s responsibility to notify the office if the status of this consent changes.
Should be Empty: