FA Media Form

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MEDIA RELEASE / CONSENT


	I give permission for ______________________________’s picture to be used by Friendship Adventures for travel purposes or in any related way (such as our website and brochures).

	__________ Please initial here if you do not want participant’s picture used.

	____________________________________ Parent / Guardian Signature	______________________________ Date	_____________________________ Relationship to Participant





	I consent and authorize the taking of photographs, videotapes, and motion pictures of _____________________________. I understand that the resulting materials may be used for informational presentations about Friendship Adventures.

	__________ Please initial here if you do not want applicant’s picture used.

	____________________________________ Parent / Guardian Signature	______________________________ Date	_____________________________ Relationship to Participant