Photo and Video Release Form
Full Name
First Name
Last Name
Are you signing for yourself or a minor
I am signing for myself
I am a parent/guardian signing for a minor
If signing for a minor, please provide the child’s name
First Name
Last Name
Email
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Authorization and Release Agreement
I grant reBloom Collective permission to photograph or video me or my child during volunteer activities and to use these images in print, online, and social media to share the impact of the organization. I understand that no last names will be used without additional permission.
I understand that I will/ will not receive any monetary compensation.
I/We, the undersigned, hereby agreed that we have read this agreement and bounded by it.
Signature
Date Signed
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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