Media Release Form (English)

Please review before signing:

By completing this form, I agree to be photographed, videotaped, and/or recorded by Solid Ground. I understand that Solid Ground may use this media (photographs, videotape, recordings, and/or my statements), in whole or part, in Solid Ground materials such as:

⇒printed publications (e.g., brochures, newsletters, etc.) ⇒website (www.solid-ground.org) ⇒videos ⇒blogs and other social media ⇒grant proposals ⇒promotional materials to support Solid Ground and its programs (including the materials of funders who request photos of the people we serve)

I also understand that Solid Ground will own all rights to this media and may choose to use and/or publish some, all, or none of it. As far as I know, what I say and do in this media will not violate the rights of any other person or company.

If I no longer want my photos and/or story to be used, I agree to contact Solid Ground at publications@solid-ground.org. Once requested, Solid Ground will not create new materials using participants’ media – but we may continue to use already printed materials until we can make replacements.

Date*
MM slash DD slash YYYY
Participant Name*
First Last
Phone*
Email*
Address*
Street Address City State ZIP Code
Group, Program, or Activity*
Please briefly describe how you are participating with Solid Ground today.
Solid Ground may print our...*
- Full Names
- First Names Only
- Pseudonyms
Only use our media for the following purpose (then delete):
Children under 18*
Please list the first and last names of children under 18 years old (or type N/A if no children to list):
Signature*