LightZ of Hope Photo Release

Authorization for Use of Photographs, Videos and Images
Name of Child in Photo

First NameLast Name
Child's Primary Diagnosis
Child's Secondary Diagnosis (if any)
Age of Child in Photo
In a couple of sentences, please tell us about your child
Name of Parent or Guardian (if person in photo is a minor)

First NameLast Name
By submitting this form, I understand that:

Lightz of Hope (Zachary Woodard Foundation) (the “Company”) utilizes various internal and external marketing efforts to promote awareness of their platform. This includes, but is not limited to, digital marketing, and traditional written marketing materials, and the Company’s internet website/intranet. The Company’s internal and external marketing materials may include images of its employees and recipients of LightZ of Hope party lights or the CareZ program. Participating in the Company’s marketing initiatives is voluntary. Furthermore, all persons who give consent to the Company to use their likeness for the above expressed purposes will not receive any additional compensation.
By your signature below, you expressly acknowledge, agree to and consent to the Company’s creation and use of photographs, videos, or images of you (both individual and group) in any of its publications, written materials or websites without prior consent or compensation. No pictures or recordings will take place in those areas prohibited under state or federal law. Your signature below confirms that you acknowledge, agree to and consent to the Company using your likeness for the above expressed purposes.

I hereby declare that I give my full consent to this release and understand this release is legally binding to me and to the Institution by which I give my release to the photographs.
Consent for Minor

The person in this photo is a minor and I am giving consent as the parent or legal guardian
Signature of Person in Photo (if over the age of 18)

Clear
Date Signed

MonthDayYear
Date
Parental Consent:
Name of Parent/Guardian (if person in the photo is a minor)

First NameLast Name
Parents' Shipping Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parents' Email
example@example.com
Parents' Mobile Phone
Please enter a valid phone number.
Signature of Parent/Guardian

Clear
Date Signed by Parent/Guardian

MonthDayYear
Date
Upload Photos Here*

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Should be Empty:

Authorization for Use of Photographs, Videos and Images