Photo Release Form

Alder Springs Deaf & Blind Community

Website, Social, and Print Media Photo Release Form (10.10.20)

Name: (blank space)

Age: (blank space) Date of Birth: (blank space)

Gender: (blank space)

Phone Number: (blank space)

Email: (blank space)

Address: (blank space)

City, State, Zip Code: (blank space)


I hereby authorize, grant and allow Alder Springs to:

Initialize the following options:

(blank space) use my name: (blank space)

and/or nickname: (blank space)

(blank space) to take my photos regarding my experiences with them.

(blank space) to use my photos on Website, Facebook, Twitter, Instagram, and other social media platform and in printed materials promoting Alder Springs.

(blank space) to edit, alter, copy, or distribute the photos to print or social media advertising and marketing.

(blank space) that all photos belong to Alder Springs.

(blank space) that I will not receive any monetary compensation.

I further hereby release Alder Springs from any and all liability or cost which may arise from this agreement.

Subject Signature: (blank space) Date: (blank space)

Alder Springs Signature: (blank space) Date: (blank space)