Media Release Form InstagramThis field is for validation purposes and should be left unchanged.Your Name(Required) First Last Email Address(Required)I grant permission to Bainbridge Youth Services, hereinafter known as the "Media" to use my image (photographs and/or video) for use in Media publications including (check all that apply):(Required) Videos Social Media Website Newsletters Publications & Marketing Materials Select AllConsent(Required) I have read and understand this releaseI hearby waive any right to inspect or approve the finished photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation raising from or related to the use of the image. I have read this release before signing below, and I fully understand the contents, meaning and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.Choose one:(Required) I am 18 years of age or older and I am competent to contract in my own name I am the parent/legal guardian of the below named child Signature(Required)Enter complete legal name for electronic signatureDate signed(Required)Youth Name First Last CAPTCHA
