Release and Consent for use of name and image / photo

 

The purpose of this form is to request permission to use your photo/image and name in our scholarship program materials, website, and/or social media as part of the AWC Center for Quality Communities.

I grant permission for me/my child’s photo/image and name to be used in connection with the AWC Center for Quality Communities’ scholarship program materials, website, and/or social media, including any and all uses of video and any portraits, still pictures, or other photographic reproductions and sound recordings in which I/my child may be portrayed.

Nothing herein shall constitute any obligation on the part of the AWC Center for Quality Communities to make any use of any of the materials or rights granted.

I hereby grant permission and execute this release as of the date and year below.

  • (required for minors under 18 years of age)
  • Date Format: MM slash DD slash YYYY

If you or a parent or guardian wish to rescind this agreement and remove your child’s information or photo, you may do so at any time in writing by sending a letter to the AWC Center for Quality Communities and such rescission will take effect upon receipt by the Communications department.

If you have questions, contact Karen Tanner at karent@awcnet.org or 1-800-562-8981.