Social Media Photo/Video Release Form

Social Media Photo/Video Release Form
Name*

First NameLast Name
Birth Date*

DayMonthYear
Email*
example@example.com
Authorization and Release
What is your preference regarding the use of your name?*

I consent to the use of my complete name.I consent to the use of my first name only.I consent to the use of my photographs and videos anonymously.
Please check the boxes regarding your preference.*

I authorize Autism-Europe to take my photographs and record videos of me.I authorize Autism-Europe to use photos and videos of me and any other creative outlet I provide on audio files, photographs, or drawings etc. on Facebook, Twitter, Instagram, and other social media platforms.I authorize Autism-Europe to edit, alter, copy, or distribute the photos and videos of me and any other creative outlet I provide on audio files, photographs, or drawings etc. for social media advertising and marketing.I agree that I will not receive any monetary compensation for usage of my photographs and videos and any other creative outlet I provide on audio files, photographs, or drawings etc. in social media platforms.I am older than 18 or my parent/legal caregiver has given consent and filled this form in on my behalf.I acknowledge I can remove my consent whenever I wish to, after which Autism-Europe will try to delete photos and videos of me where possible.
Signature*
Date Signed*

DayMonthYear
Date
Should be Empty:

Authorization and Release