BCFH - Media Permission Form

Media Permission Form
BC Family Hearing Resource Society (BCFHRS) uses media for educational and promotional purposes. Photos, audio and video recordings may be used for education and training for your family, other families and professionals, as well as general publicity, including social media.

I give permission for BCFHRS to use the following media of my family without compensation for the following purposes (please select all that apply):
Photographs:

Education and training for my familyEducation and training for other familiesEducation and training for professionalsGeneral publicity including social media
Audio recordings:

Education and training for my familyEducation and training for other familiesEducation and training for professionalsGeneral publicity including social media
Video recordings:

Education and training for my familyEducation and training for other familiesEducation and training for professionalsGeneral publicity including social media
Would you like to be contacted prior to the use of media of your family (as indicated above)?**

YesNo
This agreement will be reviewed annually.

By signing below, I confirm that I agree to the terms laid out above.
Child's Name*

First NameLast Name
Child's Date of Birth*

MonthDayYear
Date
If you wish to be sent a digital copy of this form, please enter your email address here.
example@example.com
Name of parent/legal guardian filling out this form*

First NameLast Name
Today's Date*

MonthDayYear
Date
Signature*

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