By checking the box below, I acknowledge my understanding that my story, photo, and voice is my own and hereby grant permission to RaiseUp Families to:
1) Be interviewed
2) Record and use my voice
3) Take pictures of my image
4) Be videotaped
5) Use my recorded and/or written testimony
I understand:
1) that the information I provide may be edited and shared both immediately and in the future with RaiseUp Families and its audiences on websites, in videos, and on other public online forums (email, social networking sites, newsletters, etc.) for the purposes of education, promotion, and building awareness and I consent to my testimonial being used as RaiseUp Families sees fit.
2) that media shared on the internet is subject to sharing and is accessible globally. There is no time limit on the validity of this release. However, I have the right to retract my consent after the production of the video, website, etc. I understand at any time I am entitled to revoke that authority for future use by completing a Revocation of Authorization form. If this authorization is revoked, the revocation will not apply to previous uses or disclosures the organization has made in good faith under this authorization.
3) that I waive any right of inspection or approval of my appearance or information or the uses to which that appearance or information may be put.
4) that I will not receive any compensation.
5) that RaiseUp Families will not provide services in exchange for my interview/testimony.
6) that I am at least 18 years of age.
