Media and/or Fundraising Participation Consent Form

I hereby grant Catholic Social Services the right and permission to use and/or publish my or my family members’ photograph, voice, artwork, creative writing and/or image in any media or fundraising purpose for promotion of Catholic Social Services’ programs, advertising or other lawful purpose.

Media will be defined to include photographic, audio, visual, electronic, or combined recordings of CSS facilities, clients and staff in any medium in which a likeness, voice, or discussion may be recorded in print, audio or visual, electronic or display. Media includes newspapers/magazines (articles and advertising), radio (audio recordings), television (live and/or video recordings); print media such as brochures, newsletters, etc.; other electronic media such as web sites on the Internet; and other visuals such as displays.

Fundraising will be defined as activities coordinated, sponsored or endorsed by the agency to generate or solicit funds from the community.

I hereby waive any right to inspect or approve the finished product or the advertising text that may be used in connection therewith, or the use to which it may be applied.

I release, discharge, and agree to hold harmless Catholic Social Services, or its program, from any liability by virtue of any use whatsoever of said photographs or images.

I understand that participation in any media or fundraising event for Catholic Social Services is strictly voluntary and my eligibility to receive services is not contingent upon participating in any media or fundraising event.

This consent is valid until revoked unless specified below.