Celebrate Bristol Photo Contest: Photo Release Form

"Celebrate Bristol" Photo Contest Release Form
Thank you for your interest in participating in the "Celebrate Bristol" Photo Contest from Wheeler Health, designed to highlight the wonderful aspects of the city as well as Wheeler's move to One Hope Street in downtown.

Images from all cameras, cell phone, digital, and traditional film are welcome, and 12 images will be selected by members of the community. Winning photos will appear in a Wheeler-produced 2025 calendar, which will be distributed free while supplies last. Selected photos may also appear in our new community health center.

Participants are asked to refrain from submitting photos of people without express permission. A Wheeler media release form is available for this purpose.

If you have additional questions, or need a copy of the media release form, please contact Joanne Janes, Associate Director, Communications, Wheeler, 860.793.4403 or jjanes@wheelerclinic.org.
Submissions are due by July 26, 2024
Photo Owner

Please provide specific details below.
Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

List of Images to be released

Rows	File Name	Description	Date	Location
1
2
3

Each photo should be no more than 4MB. If your photo is selected, we may contact you to request a higher-resolution image.
Upload Image 1

Browse Files

Cancelof
Upload image 2

Browse Files

Cancelof
Upload Image 3

Browse Files

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Tell us about your images (s)!

In the space provided below, share a little bit more about your images, e.g., location of photo, why it's meaningful, related stories or facts, etc.
Image #1
This photo was taken at: . This photo is significant because.
Image #2
This photo was taken at: . This photo is significant because .
Image #3
This photo was taken at: . This photo is significant because .
Consent / Permission
I authorize and grant Wheeler Health permission to consider my photos as part of its Celebrate Bristol Photo Contest.If selected, I grant Wheeler Health permission to use my photos in a 2025 Wheeler-produced calendar, and potentially in other print, or digital materials, as well as social media platforms such as Facebook, Twitter, LinkedIn, Instagram.I allow Wheeler Health to use my photos for advertising and marketing purposes.Wheeler Health may use my name in advertising, marketing, and other materials as it relates to my photo submission(s).I understand that I will not receive monetary compensation for my photos.If selected, I authorize Wheeler Health to feature my photo at its new community health center at One Hope Street.I do not authorize Wheeler Health to resell or use my photos.
Signature of Photographer/Applicant/Artist

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Date Signed

MonthDayYear
Date
Should be Empty:

"Celebrate Bristol" Photo Contest Release Form

Photo Owner

Consent / Permission