CAMP - MEDIA AND CONTENT RELEASE FORM

CAMP - Media Consent & Release

I understand that the purpose of all public relations efforts initiated by ADEC, Inc. are to promote community education and encourage public support for persons with disabilities and ADEC, Inc. as the service provider. I understand that ADEC, Inc. will use my (the individual for whom I am guardian/my family member’s) likeness in photographs/videos/recordings/media for the purpose of: updating and/or the of creation flyers, the ADEC website, brochures, commercials, billboards, posters, fundraising activities, promotional materials, human resources advertising, radio advertising, news releases/stories and social media. I understand that ADEC, Inc. may edit, alter, copy, exhibit, publish and/or distribute these photos/videos/recordings/media for purposes of publicizing ADEC, Inc.’s programs or for any other lawful purpose. Additionally, I understand that I will not receive and am not entitled to any royalties or other compensation arising or related to the taking of and use of the photographs/videos/recordings/media. I understand that I hold harmless, release and discharge ADEC, Inc. from all claims, demands, and causes of action which I, my heirs, representatives, executors or any other persons acting on my behalf or on the behalf of my estate have or may have by reason of this authorization. I understand that this consent will last for a term of three (3) consecutive years from the date of signature and can be used for future photos/videos/recordings/media during that period of time. I further understand that I can revoke this release at any time by contacting ADEC’s Mission Advancement department.

Name of individual:

Individual is over 18 and does consent to a Media Release:

I agree. (Sign below.)

I am 18 years of age, emancipated, and I am able to sign representing myself. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.

Individual is under 18 or has a legal guardian who does consent to a Media Release:

I agree. (Sign below.)

I am the guardian of the individual and do hereby give my consent without reservation to the foregoing on behalf of this person.

Consent & Release Declined:

I do not agree. (Sign below.)

I am the individual, or the guardian of the individual and do not give my consent to the foregoing.

Individual's or Guardian's printed name:(Required)

Signature:(Required)

Date:(Required)