Consent for Photography and Authorization for Publication
I hereby give my consent for photography, filming, videotaping and/or audio recording or other means of capturing my image or voice and/or being quoted in the media or printed materials (including social media and websites) to Planned Parenthood of the California Central Coast and The Bunker SLO.
I authorize the use of such for any of the following purposes:
As part of a public exhibition of photographs or artwork;
As part of a webpage, slideshow video, or other electronic presentation;
As part of an agency publication, such as a newsletter or brochure;
As incorporated in advertising or media outreach on behalf of the agency; and
In other formats that may be viewed or distributed publicly.
I hereby waive any right to compensation for such uses by reason of the foregoing authorization. I and my successors or assigns hereby hold the Planned Parenthood of the California Central Coast, The Bunker SLO and its personnel and affiliated programs harmless for any and all liability which may or could arise from activities authorized by this agreement.
Authorization will expire 12 months after the date of signature of this form. Upon expiration of this Authorization, Planned Parenthood of the California Central Coast and The Bunker SLO will not permit further release of any photography or information, but will not be able to call back any photography or information already released.
I and my successors or assigns may rescind this Authorization up until a reasonable time before the photography, video, or recordings are used, but I must do so in writing.
I have a right to receive a copy of this authorization.