Personal Information

Full Name Email Address Phone Number

Media Consent

I consent to the use of my photo in social media content.

I consent to the use of my video in social media content.

I consent to the use of my audio recordings in social media content.

I consent to the use of my story/testimonial in social media content.

Waiver and Release of Liability

I understand and agree that by granting consent, I release and hold harmless the organization and its representatives from any and all claims, liabilities, and demands arising out of or in connection with the use of my likeness or information as described above, on any platform including but not limited to social media, websites, and promotional materials.

I have read and agree to the waiver and release of liability statement.

Signature

Signature Date

Social Media Content Media Waiver and Liability Form

Personal Information

Media Consent

Waiver and Release of Liability

Signature