Media Release of Information
This form will take approximately 5 minutes to complete.
I hereby grant Chosen Care Inc. the right of possession of any photographs or video footage of me for select promotional purposes. If my child is participating in any photo shoots, I understand that all waiver criteria applies to him and/or her, as well, and I release Chosen & related officials from liability. I agree that my personal information will not be made publicly available. I acknowledge that the Released Parties are not responsible or liable for any unauthorized use or piracy of the Content. I represent and warrant that I am at least 18 years of age and have the full legal capacity to execute this release on my own behalf, or on the behalf of a minor as their parent or legal guardian. I acknowledge and agree that this release is binding upon my heirs and assigns.
By checking the box "Yes" you are authorizing to use photographs or video footage of me for select promotional purposes :
Description & Locations:
Please list the following footage you are authorizing Chosen Care, Inc. to use.
Street Address Line 2
State / Province
Postal / Zip Code
Please enter a valid phone number.
Should be Empty: