Media Release Form

West Central Arkansas Planning & Development District

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I ________ , grant permission to West Central Arkansas Planning and Development District, hereinafter known as the "Media" to use my image (photographs and/or videos) to use for Media publications including: *

Check All That Apply *

Videos
Email Campaigns
Recruiting Brochures
Newsletters
Magazines
General Publications
Website
Social Media
Other

I hereby waive the right to inspect of approve the finished photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the image. *

Please select which is applicable to your current situation: *

I am 18 years of age or older and I am competent to contract in my own name. I have read this release before signing below, and I fully understand the contents, meaning and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.
I am the parent or legal guardian of the below named child. I have read this release before signing below, and I fully understand the contents, meaning and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.

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