Media Release Form

Media Release Form

[photos | videos | testimonials | profiles | media interviews]
I grant TayCo Brace, Inc. permission to use my name, information, images and/or recordings of me for public relations, web pages and other promotional materials produced, used by and representing TayCo Brace. I understand the circulation of these materials could be worldwide and that there will be no compensation to me for this use. If indicated below, I am granting this same permission for my minor child.

I therefore hold TayCo Brace, Inc. and its partners harmless for any and all actions resulting from the use of my or my child’s name, information, images, and/or recordings.
Your Name or Name of Minor

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address
example@example.com
Signature/Signature of Parent or Legal Guardian
If signing for a minor: I certify that I am the parent or legal guardian of the minor child named above, and I give my consent without reservation for the foregoing on their behalf.
I agree to the terms and conditions regarding media release.
Should be Empty: