Video & Photo Release Form
Name of person completing this form
First Name
Last Name
Are you completing this form for someone under the age of 18?
*
Yes
No
Name of person under the age of 18
First Name
Last Name
How are you related to the volunteer?
Are you volunteering as part of a company event/initiative?
*
Yes
No
I am volunteering as a representative of my company/group (
blanks
) located in
city
,
state
Date of Birth (OPTIONAL)
-
Month
-
Day
Year
Volunteers younger than 16 must be accompanied by a parent or caregiver at all times. Some volunteer opportunities may require an individual to be 18+ and/or 21+. If you have questions regarding your activity, please email reach@reachreads.org
Which age group best represents the person who is volunteering?
I am 17 or younger
I am between the ages of 18-24
I am between the ages of 25-44
I am between the ages of 45-64
I am 65 or older
Gender
*
Please Select
Male
Female
non-binary
other
I choose not to disclose
Phone Number
-
Area Code
Phone Number
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Authorization, Release, and Consent
Can we use your name?
*
Complete name
First name only
*
I authorize and grant {REACH and it's partners} to take/use my photos/videos regarding my experiences with them.
I grant {REACH and it's partners} to use my photos on Facebook, Twitter, Instagram, and other social media platform.
I allow {REACH and it's partners} to edit, alter, copy, or distribute the photos/videos for social media advertising, programming and marketing.
I agree that the photos belong to {REACH and it's partners}.
I understand that I will not receive any monetary compensation.
Signature
*
Date Signed
*
-
Month
-
Day
Year
Date
Submit
Print Form
Should be Empty: