Media Release Form:
Platform(s): Photography Video Audio
Media Type(s): Publications Print Television Radio Web
I, ________________________________ , give consent to be interviewed, photographed and/or
videotaped by________________________________________________________ .
I also agree that Goodwill Industries of the Southern Rivers, Inc. may provide the name of the subject to standard broadcast media outlets, publications, and websites for the purposes of this article/photo/videotape, indefinitely, And, further, the subject will not accept any monetary payment in return for this service and aforementioned rights.
Subject Signature: __________________________________________________________
Parent/Guardian Signature: ___________________________________________________
*IMPORTANT - The original of this form must be kept with the subjects permanent file in the People Services Dept, for employees, or in Workforce Development, for trainees.
Please return a copy of this form to: