Your Community Health Consent Form - Your Community Health

Your Community Health image and artwork consent form

Your Community Health regularly reproduces photographs and videos of people, as well as artworks for use in our public-facing publications, website, social media and promotional and marketing materials. These images and artworks allow us to celebrate our clients, milestone events and the daily work we do to care for the community. Rights to use images/artworks: We request the right to publish images of you and/or your artworks. You can contact us at [email protected] to ask that we stop using the images at any time. Owner of the image: Your Community Health and the photographer or videographer will own the images and they may be used across our website, social media and promotional materials. You can contact us at [email protected] to ask that we not use your image in certain ways or ask us to stop using the images at any time.

What is the event you are participating in?(Required)

Who is taking the photos/videos you are consenting to?(Required)

I acknowledge that the images are owned by Your Community Health. I hereby grant Your Community Health the right to use my image, artwork or image of my artwork:(Required)

Yes

I consent to Your Community Health using my image, artwork or image of my artwork in the following places:(Required)

Anywhere (unrestricted use)

Publications (brochures, posters, flyers, reports)

Website

Social media (Facebook, Instagram, etc.)

Date:(Required)

Name:(Required)

First Last

Phone:(Required)

Email:(Required)

Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Identifying features (i.e. red top, blue glasses):(Required)

If you are under 18 years of age, does your parent/guardian consent?:

Yes

Parent/Guardian Name

First Last

Phone

If you would like a copy of the images, please confirm your email address here:

Comments

This field is for validation purposes and should be left unchanged.

Your Community Health image and artwork consent form

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