Publicity Consent Form ↘

Name *

First Name

Last Name

Please check the boxes if you agree. *

I hereby grant voluntarily and without monetary compensation YWCA Minneapolis permission to:

Make video and audio recordings of me and/or my voice.

Take and use photographs of me and/or my family.

Record, use, display and disclose in a video and/or other media intended for public consumption statements and/or information provided by me concerning myself and/or my family.

Use the activities listed above for direct mail, advertising, public relations, website, email, social media, blogs and other efforts related to the promotion of YWCA Minneapolis.

Use my name and the names of members of my family in conjunction with the activities listed above.

I do not agree with the above.

Please check the box if you agree. *

With respect to the above, I relinquish to YWCA Minneapolis all rights, title and interest I may have in all originals, edited versions, reproductions, and copies of any video and/or audio recording(s), prints, negatives, digital images, and photographs in which my or members my family’s name, image, statements, information, and/or voice is used (the “Materials”).

I do not agree.

Please check the box if you agree. *

I also irrevocably grant YWCA Minneapolis permission to copyright, if applicable, the Materials, and to use, reuse, copy, publish, display, exhibit, reproduce, license to a third party, and distribute the Materials in any manner and for any reason YWCA Minneapolis may deem proper, including the right to use the same for purposes of advertising or trade. By signing this Publicity Consent Release, I acknowledge that YWCA Minneapolis is not responsible for the unauthorized use of the Materials by unrelated third parties.

I do not agree.

Please check the box if you agree. *

I hereby release YWCA Minneapolis from liability for any damages that may arise from the unauthorized use of the Materials by a third party. NOTE: If you should no longer like YWCA Minneapolis to use your image in its awareness and education materials and activities, please contact YWCA Minneapolis. Due to the distribution and printing timelines, some of the materials YWCA Minneapolis may not be able to remove your image immediately from its pieces, but will do so as soon as those print pieces are scheduled for reprinting or new production. Print materials that are distributed to public audiences may not be recalled once distributed. Materials used for emails, website, social media or other online efforts may be removed from YWCA sites and networks, but due to the nature of the internet, may remain available online through other sources indefinitely.

I do not agree.

What YWCA Minneapolis program(s) are you involved in?

Health and Wellness

Racial Justice and Public Policy

Girls and Youth

Early Childhood Education

Donor/Events/Volunteer

Name of Minor Child (if applicable)

First Name

Last Name

Name of Minor Child (if applicable)

First Name

Last Name

Name of Minor Child (if applicable)

First Name

Last Name

Date *

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