Media Release Permission Form
This information is entirely confidential.
Full Name of Parent/Guardian completing this form
Full name of child receiving services from the BC Family Hearing Resource Society:
Do you give us permission to record and use any photos, video, audio, or social media posts of you and your family?
Yes (select to choose which you would like to allow)
I/We hereby voluntarily and without compensation authorize the use of the following media by the BC Family Hearing Resource Society of me/us and my/our child, along with any siblings that may attend sessions, groups or events.
I/We consent for these media to be used by the BC Family Hearing Resource Society in the following:
Social media posts/campaigns
Information brochures and pamphlets
Education and training materials for professionals
Education and training materials for parents/families
Would you like to be contacted each time any of the media (as indicated above) of you, your child, or your family is used?
By signing below, I provide permission for the BC Family Hearing Resource Society to use the forms of media indicated above for the purposes indicated above:
By signing below, I confirm that I choose NOT to give permission for the BC Family Hearing Resource Society to use photographs, audio and/or video recordings, or social media of me/us and my/our child, along with any siblings that may attend the sessions.
Should be Empty: