Media Release Form
  • Release for use of name, likeness, photograph and video

    Media Release Form
  • I hereby grant United Way of Greater Atlanta and its respective subsidiaries, affiliates, successors and assigns and other such persons as United Way of Greater Atlanta may designate from time to time, the absolute right and permission to use in perpetuity my name, likeness, voice and photograph(s), in video or in still photography, in whole or in part, or distorted in character or form, either alone or accompanied by other material, throughout the world, for the purpose of advertising, publicity, trade or any other lawful purpose whatsoever, in any media now known or ever developed.

    I hereby waive all my rights to inspect and approve the finished product, its use or such written or spoken copy as may be used in connection therewith.

    I agree that I will not hold United Way of Greater Atlanta or anyone who receives permission from it, responsible for any liability resulting from the use of my name, likeness, voice and photograph(s) in accordance with the terms hereof and agree to waive and release any such claims, including any distortion, optical illusion or faulty reproduction which may occur in the finished product, which might be challenged as being a misrepresentation of me, my character or my person, as well as any claim that use of such photograph constitutes an invasion of privacy.

    I am over 18 years of age and have the right to make this agreement.

  • Date
     - -
  • (If signatory is under 18, the parent or legal guardian should disregard the last sentence above and sign below)

  • I, as parent/ legal guardian of , agree to the above and I sign this document to signify my agreement.

  • Date
     - -
  • Should be Empty: