I (the releaser) hereby grant Southeast Cancer Support Services (hereafter referred to as SCSS) permission to use the below listed child/minor’s image to promote SCSS in all forms, media and manners, including but not limited to: news releases, photographs, videos, audio, website, social media, marketing, advertising and promotion for an indefinite period of time.

I agree that these images may be used for a variety of purposes with regards to the promotion of SCSS and that these images may be used at any time without further notifying me.

I understand that by signing this release form, that there shall be no payment, no royalty fee nor compensation to me or my child/minor, for use of the images and I further understand that my authorization will be kept for as long as deemed relevant and after that time it will be destroyed or archived.

Description of the event in which images may be acquired:

Hope in Heels, April 10, 2025 and and rehearsals or events leading up to and related to Hope in Heels, April 10, 2025. 

This release expresses the complete understanding of the parties. The Releaser and SCSS understand and agree to the terms and conditions.

MEDIA & PERSONAL INFORMATION RELEASE FORM - MINORS

8 + 12 =