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Photo Release

Photo Release Form

Fields marked with an * are required

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By submitting this form the undersigned hereby authorizes Placer Community Foundation and their agents, promoters, sponsors, and all persons and organizations affiliated with this organization (including Placer Housing Matters) to interview, make an audio recording (tape recording) or photograph (still photography in any format) or make an audio visual recording (motion picture, videotape, video disc, and any other mechanical means of recording and reproducing images) of the following persons:

The undersigned agrees that Placer Community Foundation (and/or as "Placer Housing Matters") may use and permit other persons to use the names/photographs/materials gathered for such purposes including, but not limited to, any broadcast, telecast, newsprint, social marketing, and/or any other use. The undersigned further agrees that Placer Community Foundation (including Placer Housing Matters) may disseminate this information for public, educational, public relations, marketing and charitable purposes and that such dissemination may be accomplished in any manner.

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The undersigned has entered into this agreement to assist the organization listed above in their efforts and hereby waives any right to compensation for such uses by reason of the foregoing authorizations. The undersigned and his/her successors hereby hold the Placer Community Foundation and their successors harmless from, and against any claim for, injury or compensation arising out of the activities authorized by this agreement.

If submitted by other than person named in 1-4 above, or the subject is under the age of 18, please indicate relationship here. Only an adult, guardian or parent can submit for any person under the age of 18.

I understand that by clicking submit it constitutes a legal signature confirming that the above information is true and correct and that I am legally authorized to assent to and sign this form.

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